CMS Price Transparency Data

Bunion correction surgery

Facility: Hospital for Special Surgery

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $12,177
Cash Discount Price: $15,623
vs. Medicare Baseline: 3.64x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Hospital for Special Surgery is $12,177. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,623. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 3.64x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$15,623

Average discount available for prompt cash payment at this facility.

Insurance Median

$12,177

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: $15,623 (467%)

Insurance Median: $12,177 (364%)

Cash: $15,623 (467% of Medicare)

Ins. Median: $12,177 (364% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 364% of the Medicare baseline (a markup of 264%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Metro Plus	$346 - $1,001	10%
Fidelis	$411 - $911	12%
Emblem	$548 - $1,771	16%
UnitedHealthcare	$548 - $14,759	16%
Cigna	$1,069 - $12,245	32%
Nyship	$1,164 - $2,037	35%
Horizon	$1,325 - $1,834	40%
Aetna	$1,475 - $12,267	44%
Blue Cross Blue Shield	$1,560 - $12,343	47%
Affinity By Molina Health Plan [1005]	$8,105	242%
Oxford [1096]	$9,451	283%
Emblem Health [1043]	$10,676 - $12,343	319%
Geha [1053]	$12,177	364%
Student Resources [1103]	$12,177	364%
Apwu [1016]	$12,245	366%
Nalc [1090]	$12,245	366%
Qualcare [1101]	$12,245	366%
Wellfleet [1361]	$12,245	366%
Christian Brothers [1034]	$12,267	367%
Meritain Health [1085]	$12,267	367%
Nippon Life [1092]	$12,267	367%
Webtpa [1356]	$12,267	367%
Connecticare [1039]	$12,343	369%
Harvard Pilgrim [1057]	$14,759	442%

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 $15,623.
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 Hospital for Special Surgery 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.