CMS Price Transparency Data

Bunion correction surgery

Facility: St Claire Regional Medical Center

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $533
Cash Discount Price: $883
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at St Claire Regional Medical Center is $533. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $883. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.16x the Medicare baseline. Located in 222 Medical Circle, Morehead, KY.

Cash / Self-Pay

$883

Average discount available for prompt cash payment at this facility.

Insurance Median

$533

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: $883 (26%)

Insurance Median: $533 (16%)

Cash: $883 (26% of Medicare)

Ins. Median: $533 (16% 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
Blue Cross Blue Shield	$461 - $816	14%
Caresource Mcr Adv	$461	14%
Humana	$461 - $576	14%
Healthlink - All Plans	$489	15%
Wellcare Comm - All Other Plans	$576	17%
Ky Health Co-Op - All Plans	$599	18%
Caresource Just4Me - All Other Plans	$646	19%
Aetna	$1,177	35%
Medicaid / KanCare	$1,177	35%
Wellcare Mcaid	$1,201	36%

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 $883.
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 Claire Regional 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.