CMS Price Transparency Data

Bunion correction surgery

Facility: St Mary Medical Center

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $3,741
Cash Discount Price: $22,469
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at St Mary Medical Center is $3,741. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $22,469. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 1.12x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.

Cash / Self-Pay

$22,469

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,741

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: $22,469 (672%)

Insurance Median: $3,741 (112%)

Cash: $22,469 (672% of Medicare)

Ins. Median: $3,741 (112% 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
Aetna	$1,573 - $3,733	47%
Medicaid / KanCare	$1,628 - $2,822	49%
UnitedHealthcare	$1,958 - $3,742	59%
Keystone First	$2,581	77%
Keystone First Chip	$2,581	77%
Amerihealth	$3,220	96%
Blue Cross Blue Shield	$3,220 - $7,225	96%
Blue Shield - Ca	$3,220	96%
Blue Shield - Id (Regence)	$3,220	96%
Blue Shield - Ny Highmark Western	$3,220	96%
Blue Shield - Wa (Regence)	$3,220	96%
Cigna	$3,561 - $5,081	107%
Align Senior Care	$3,598	108%
Medicare (plans)	$3,616 - $6,349	108%
Geha	$3,742	112%
Health America Advantra	$4,233	127%
Upmc Health Plan	$5,081	152%
Webtpa	$5,081	152%
Ambetter / Centene	$6,296	188%
Oscar	$6,349	190%
Prime Healthcare	$6,349	190%
Jefferson Health Plan Commercial	$6,420	192%
Homestead Health Plans Woods Center	$6,878	206%
Group Pension Administrators	$7,937	237%
Reedman Toll	$7,937	237%
Blue Shield - Pa (Highmark)	$9,538	285%

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 $22,469.
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 St Mary Medical Center 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.