CMS Price Transparency Data

Bunion correction surgery

Facility: Mon Health Medical Center

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $1,043
Cash Discount Price: $538
vs. Medicare Baseline: 0.31x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Mon Health Medical Center is $1,043. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $538. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.31x the Medicare baseline. Located in 1200 Jd Anderson Drive, Morgantown, WV.

Cash / Self-Pay

$538

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,043

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: $538 (16%)

Insurance Median: $1,043 (31%)

Cash: $538 (16% of Medicare)

Ins. Median: $1,043 (31% 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
Maryland_Physicians_Care_Plan	$753	23%
Aetna	$860 - $3,165	26%
The_Health_Plan_Murray_Energy_Commercial_Aso_Plan	$860	26%
The_Health_Plan_Plan	$925	28%
Acpn_Plan	$968	29%
Cigna	$968	29%
Humana	$968 - $3,165	29%
Mon_County_Commission_Plan	$968	29%
Uhc_Plan	$968	29%
Health_Payors_Organization_Plan	$989	30%
Uhc_Options_Ppo_Plan	$1,000	30%
Multiplan_Phcs_Plan	$1,022	31%
Mutual_Of_Omaha_Plan	$1,022	31%
Geha_Plan	$1,043	31%
Three_Rivers_Plan	$1,043	31%
Uhc_Onenet_Ppo_Plan	$1,043	31%
Upmc__Plan	$1,043	31%
Zelis_Other_Plan	$2,690	80%
The_Health_Plan_Peia_Plan	$2,830	85%
Blue Cross Blue Shield	$3,165 - $15,035	95%
Health_South_Mountain_View_Plan	$3,165	95%
Medicare (plans)	$3,165	95%
Paramount_Elite_Plan	$3,165	95%
Uhc_Va_Plan	$3,165	95%
Zelis_Group_Health_Plan	$3,165	95%
Seven_Corners_Plan	$6,330	189%

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 $538.
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 Mon Health 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.