CMS Price Transparency Data

Bunion correction surgery

Facility: St Luke's Wood River Medical Center

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $7,535
Cash Discount Price: $8,372
vs. Medicare Baseline: 2.25x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at St Luke's Wood River Medical Center is $7,535. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,372. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 2.25x the Medicare baseline. Located in 100 Hospital Drive, Ketchum, ID.

Cash / Self-Pay

$8,372

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,535

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: $8,372 (250%)

Insurance Median: $7,535 (225%)

Cash: $8,372 (250% of Medicare)

Ins. Median: $7,535 (225% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 225% of the Medicare baseline (a markup of 125%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Commercial [1028]	$4,772 - $8,121	143%
Medicare (plans)	$4,772 - $4,867	143%
Veterans Affairs [1056]	$4,772	143%
Blue Cross Blue Shield	$4,820 - $7,158	144%
UnitedHealthcare	$5,011 - $7,577	150%
Aetna	$5,249 - $7,953	157%
Moda [1055]	$7,367	220%
Geha [1065]	$7,577	227%
United Medical Resources [1051]	$7,577	227%
Cigna	$7,786	233%
Providence [1022]	$7,786	233%
Pacificsource [1020]	$7,870	235%
First Health [1064]	$7,953 - $8,121	238%
Webtpa [1071]	$7,953	238%

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 $8,372.
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 Luke's Wood River 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.