CMS Price Transparency Data

Bunion correction surgery

Facility: Fort Memorial Hospital

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $3,127
Cash Discount Price: $2,294
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Fort Memorial Hospital is $3,127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,294. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.94x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$2,294

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,127

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: $2,294 (69%)

Insurance Median: $3,127 (94%)

Cash: $2,294 (69% of Medicare)

Ins. Median: $3,127 (94% 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
Molina	$510 - $3,127	15%
UnitedHealthcare	$625 - $3,127	19%
Fort Care	$1,555	47%
Blue Cross Blue Shield	$2,395 - $4,186	72%
Dean Health Plan	$2,395 - $7,419	72%
Medicaid / KanCare	$2,395	72%
Quartz	$2,395 - $5,135	72%
Group Health Cooperative	$2,512 - $4,589	75%
Managed Health Services	$2,611	78%
Aetna	$2,861 - $5,320	86%
Humana	$3,127 - $8,014	94%
Medicare (plans)	$3,127	94%
Veteran Evaluation Services	$3,746	112%
Alliance	$5,091	152%
Mercycare	$5,281	158%
Trilogy	$6,238	187%
Cigna	$6,740	202%
Centivo	$7,192 - $7,492	215%

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 $2,294.
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 Fort Memorial 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.