CMS Price Transparency Data

Bunion correction surgery

Facility: Adventist Health St Helena

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $675
Cash Discount Price: $172
vs. Medicare Baseline: 0.20x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Adventist Health St Helena is $675. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $172. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.20x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$172

Average discount available for prompt cash payment at this facility.

Insurance Median

$675

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: $172 (5%)

Insurance Median: $675 (20%)

Cash: $172 (5% of Medicare)

Ins. Median: $675 (20% 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
Phcs-All Plans	$151 - $1,113	5%
Health Management Network-All Plans	$234 - $1,720	7%
Three Rivers-All Plans	$248 - $1,822	7%
Blue Shield Bh Mcr Adv	$548	16%
Blue Shield Mcr Adv	$548	16%
Kaiser Mcr Adv	$548	16%
Tricare	$548	16%
Ah Employee Health Plan - All Plans	$602	18%
Cigna	$640	19%
Interplan-All Plans	$657	20%
Kaiser-All Other Plans	$657	20%
UnitedHealthcare	$675	20%
Aetna	$783	23%
Western Growers-All Plans	$783	23%
Blue Shield Epn-All Other Plans	$1,142	34%
Blue Shield Non-Epn	$1,207	36%
Blue Cross Blue Shield	$1,408	42%

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 $172.
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 Adventist Health St Helena 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.