CMS Price Transparency Data

Bunion correction surgery

Facility: Clarion Hospital

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $3,277
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Clarion Hospital is $3,277. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.98x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,277

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%)

Insurance Median: $3,277 (98%)

Ins. Median: $3,277 (98% 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
Upmc	$471 - $3,465	14%
Workers Comp	$1,730	52%
Highmark	$3,090 - $5,178	92%
Highmark Community Blue	$3,109	93%
Amerihealth	$3,121	93%
Cigna	$3,121	93%
Martin'S Point - Usfhp	$3,121	93%
Medicare (plans)	$3,121	93%
Tricare	$3,121	93%
UnitedHealthcare	$3,121	93%
Aetna	$3,215 - $7,179	96%
Geisinger	$3,277	98%
Devoted Health Plan	$3,309	99%
The Health Plan	$3,309 - $7,335	99%
Gateway	$3,340	100%
Pa Health & Wellness	$3,340	100%
American Health Plan	$3,434	103%
Highmark - Ind.& Managed Care	$7,009	210%
Peak Health	$7,335	219%

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 $X.
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 Clarion 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.