CMS Price Transparency Data

Bunion correction surgery

Facility: Nationwide Children's Hospital Toledo, LLC

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $1,794
Cash Discount Price: $1,435
vs. Medicare Baseline: 0.54x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Nationwide Children's Hospital Toledo, LLC is $1,794. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,435. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.54x the Medicare baseline. Located in 2213 Cherry Street, Toledo, OH.

Cash / Self-Pay

$1,435

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,794

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: $1,435 (43%)

Insurance Median: $1,794 (54%)

Cash: $1,435 (43% of Medicare)

Ins. Median: $1,794 (54% 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
Caresource	$324 - $3,510	10%
UnitedHealthcare	$327 - $4,625	10%
Amerihealth	$330 - $4,669	10%
Bchp	$330 - $4,669	10%
Mcclaren Health Plan - Michigan	$345 - $3,443	10%
Paramount	$468	14%
Blue Cross Blue Shield	$492 - $4,669	15%
Mcclaren Health Plan	$655	20%
Tricare	$762 - $3,082	23%
Aetna	$1,074	32%
Front Path Health Coalition	$1,082 - $10,029	32%
Cigna	$1,155	35%
Ohc	$1,794	54%
Ohio Ppo Connect	$1,794	54%
Mmo	$2,392	72%
Molina	$3,343 - $4,625	100%
Humana	$4,669	140%

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 $1,435.
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 Nationwide Children's Hospital Toledo, LLC 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.