CPT 28495 at Summit Pacific Medical Center

Musculoskeletal

Summit Pacific Medical Center, Elma

This name is the CMS category the code belongs to (CMS's Restructured BETOS Classification System), shared with similar codes. The official CPT description belongs to the American Medical Association and isn't shown.

What Summit Pacific Medical Center publishes for this code: as an outpatient

Summit Pacific Medical Center’s prices for CPT 28495, as an outpatient
Who pays	Hospital’s fee (lowest – highest)	Doctor’s fee the hospital lists
Commercial insuranceInsurer rates	$165 – $2,8383 plans	$201
Medicare AdvantageInsurer rates	$375 – $8363 plans	$158 – $168
Medicaid managed careInsurer rates	$54.52 – $8013 plans	$112 – $123
Other government programInsurer rates	$375 – $7881 plan	$158
UnknownInsurer rates	$54.52 – $2,6803 plans	$112 – $219
Cash pricePaying yourself, without insurance	$127 – $1,703	$387
List priceBefore any discount; few people pay it	$236 – $3,153	$716

Lowest and highest amounts Summit Pacific Medical Center lists for this code as an outpatient, including lines it lists for both settings or without saying which. Its price file is dated 2026-08-31. This is one line of a bill; most care brings several.

Bills to expect

The hospital’s fee is the price above. Doctors usually send their own bills. Their amounts here are what original Medicare allows in the rest of Washington for 2026, and a private-plan estimate of 118% to 179% of that (the range found across studies of what insurers pay doctors). Those are estimates, not quotes.

Bills to expect for CPT 28495 at Summit Pacific Medical Center
Bill	What it’s for	Original Medicare allows	Private plan estimate
Hospital's feeThe hospital	The operating or procedure room, nursing, supplies and recovery	—	The price above
Surgeon or doctor doing itThe doctor's practice	The procedure, and routine follow-up visits for 90 days	$158	$187 – $283
AnesthesiaAn anesthesia group (only sometimes)	Anesthesia or deep sedation, if you need itOnly if an anesthesia team is part of your care. Its amount depends on how long it takes.	—	—

Original Medicare amounts are only for people on original Medicare. Your share depends on your plan’s deductible, copay and coinsurance.

Compare CPT 28495 at every Washington hospital, with Medicare’s reference amounts.