CMS Price Transparency Data

Bunion correction surgery

Facility: Kaleida Health

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $4,229
Cash Discount Price: $2,673
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Kaleida Health is $4,229. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,673. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 1.27x the Medicare baseline. Located in 100 High Street, Buffalo, NY.

Cash / Self-Pay

$2,673

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,229

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$3,342.87

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $3,342.87 (100%)

Cash / Self-Pay: $2,673 (80%)

Insurance Median: $4,229 (127%)

Cash: $2,673 (80% of Medicare)

Ins. Median: $4,229 (127% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $3,342.87 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Ghi/Emblem Health	$588 - $5,514	18%
Ghi/Emblem Health - Wchob	$588 - $735	18%
Aetna	$613 - $4,329	18%
Magnacare	$613 - $4,229	18%
Magnacare - Wchob	$613 - $4,229	18%
Univera	$1,138 - $5,692	34%
Univera - Wchob	$1,138 - $5,535	34%
Independent Health Association	$2,376 - $6,464	71%
Independent Health Association - Wchob	$2,465 - $6,622	74%
Blue Cross Blue Shield	$2,785 - $15,241	83%
Tricare	$3,880	116%
Wellcare	$4,248	127%
Fidelis	$4,411	132%
UnitedHealthcare	$4,432	133%
Cigna	$4,779 - $5,800	143%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $2,673.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 28296.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Kaleida Health is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 28296.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.