CMS Price Transparency Data

Bunion correction surgery

Facility: West Penn Hospital

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $602
Cash Discount Price: $395
vs. Medicare Baseline: 0.18x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at West Penn Hospital is $602. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $395. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.18x the Medicare baseline. Located in 4800 Friendship Avenue, Pittsburgh, PA.

Cash / Self-Pay

$395

Average discount available for prompt cash payment at this facility.

Insurance Median

$602

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: $395 (12%)

Insurance Median: $602 (18%)

Cash: $395 (12% of Medicare)

Ins. Median: $602 (18% 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
Amerihealth	$96 - $3,277	3%
Geisinger	$96 - $1,736	3%
UnitedHealthcare	$96 - $10,953	3%
Highmark	$453 - $7,921	14%
Life Pittsburgh	$487 - $3,121	15%
Medicare (plans)	$517 - $3,215	15%
American Health Plans	$536 - $3,121	16%
Pennsylvania Health And Wellness	$548 - $1,628	16%
Cigna	$823 - $10,357	25%
University Of Pittsburgh Medical Center	$1,194	36%
Aetna	$1,302 - $10,332	39%
Highmark Wholecare	$1,497 - $3,309	45%
Martin'S Point	$3,121	93%
Humana	$3,309	99%
Molina	$3,402	102%
Medical Mutual	$10,357	310%

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 $395.
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 West Penn Hospital 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.