CMS Price Transparency Data

Bunion correction surgery

Facility: Avita Ontario

Billing Code: 28296 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 28296
Insurance Median: $3,343
Cash Discount Price: $25,597
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Bunion correction surgery at Avita Ontario is $3,343. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25,597. Compared to the federal Medicare reimbursement reference rate of $3,342.87, this hospital’s rate is 1.00x the Medicare baseline. Located in 715 Richland Mall, Ontario, OH.

Cash / Self-Pay

$25,597

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,343

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: $25,597 (766%)

Insurance Median: $3,343 (100%)

Cash: $25,597 (766% of Medicare)

Ins. Median: $3,343 (100% 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	$625 - $21,472	19%
Buckeye	$625 - $3,343	19%
Caresource	$625	19%
Humana	$625 - $3,343	19%
Medicaid / KanCare	$625	19%
Molina	$625 - $3,343	19%
United_Healthcare	$625 - $21,758	19%
Amerihealth	$1,545	46%
Aetna	$3,343 - $30,115	100%
Medical_Mutual	$3,343 - $24,092	100%
Medicare (plans)	$3,343	100%
Mount_Carmel	$3,343	100%
Cigna	$23,459	702%

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 $25,597.
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 Avita Ontario 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.