CMS Price Transparency Data

Bunion correction surgery

Facility: Adventist Health Lodi Memorial

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $568
Cash Discount Price: $128
vs. Medicare Baseline: 0.17x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Adventist Health Lodi Memorial is $568. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $128. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.17x the Medicare baseline. Located in 975 S Fairmont Avenue, Lodi, CA.

Cash / Self-Pay

$128

Average discount available for prompt cash payment at this facility.

Insurance Median

$568

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: $128 (4%)

Insurance Median: $568 (17%)

Cash: $128 (4% of Medicare)

Ins. Median: $568 (17% 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
Healthnet Mcal	$96	3%
Hp Of San Joaquin Mcal	$96	3%
Alignment Health Plan (Ahp)-All Plans	$494	15%
Blue Shield Mcare Adv	$494	15%
Healthnet Mcare	$494	15%
Hp Of San Joaquin Mcr Adv	$494	15%
Humana	$494	15%
Knnex Health - All Plans	$494	15%
Tricare	$494	15%
UnitedHealthcare	$494 - $675	15%
Hp Healthy Kids Pro Fee	$519	16%
Ah Employee Health Plan - All Plans	$544	16%
First Health- All Plans	$593	18%
Cigna	$601	18%
Aetna	$637	19%
Beech Street- All Plans	$643	19%
Hp Of San Joaquin Ppo - All Other Plans	$643	19%
Multiplan- All Plans	$643	19%
Kaiser Commercial - All Other Plans	$667	20%
Kaiser Mcr Adv	$667	20%
Networks By Design- All Plans	$667	20%
Western Growers- All Plans	$707	21%
Healthnet- All Other Plans	$720	22%
Blue Shield Epn - All Other Plans	$1,028	31%
Blue Shield Non-Epn	$1,086	32%
Blue Cross Blue Shield	$1,369	41%

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 $128.
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 Lodi Memorial 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.