CMS Price Transparency Data

Bunion correction surgery

Facility: Tri Valley Health System

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $1,291
Cash Discount Price: $2,721
vs. Medicare Baseline: 0.39x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Tri Valley Health System is $1,291. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,721. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 0.39x the Medicare baseline. Located in 1305 West Highway 6/34, Cambridge, NE.

Cash / Self-Pay

$2,721

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,291

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: $2,721 (81%)

Insurance Median: $1,291 (39%)

Cash: $2,721 (81% of Medicare)

Ins. Median: $1,291 (39% 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	$453 - $2,788	14%
Humana	$453 - $1,291	14%
Medica Mcr Adv	$453 - $1,291	14%
Medica Prime Sol	$453 - $1,291	14%
Tricare	$453 - $1,291	14%
Wellcare Mcr Adv - All Plans	$466 - $1,291	14%
Aetna	$475 - $2,876	14%
Great Plains Mcr Adv - All Plans	$475 - $1,356	14%
Healthy Blue Mcaid - All Plans	$772 - $1,409	23%
Molina Mcaid - All Plans	$772 - $1,409	23%
UnitedHealthcare	$772 - $2,818	23%
Nebraska Total Care-All Plans	$780 - $1,409	23%
Amerigroup Mcaid - All Plans	$787 - $1,437	24%
Medica Ifb Aco	$888 - $2,642	27%
Medica Chi Aco - All Other Plans	$916 - $2,642	27%
Medica Chi Open Access	$979 - $2,642	29%
Medica Ifb Open Access	$1,134 - $2,642	34%
Multiplan-All Plans	$1,462 - $2,876	44%
Midlands Choice-All Plans	$1,631 - $2,642	49%

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 $2,721.
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 Tri Valley Health System 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.