Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
REVISION OF TOE
Low
$116
Average
$986
Median
$396
High
$2.2k
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
17 hospitals; the 90th percentile is 16.3× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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22 hospital rates
iThe hospitals that file a Medicaid rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · case rate · outpatient | 1 | $250 | $250 | — | — | — | $250 – $250 |
| 2 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $288 | $288 | — | — | — | $288 – $288 |
| 3 | Childrens Hospital of Los Angeles Angeles, CA facility · other · outpatient | 2 | $281 | $281 | — | — | — | $281 – $281 |
| 4 | Clarion Hospital Clarion, PA facility · case rate · outpatient | 1 | $250 | $250 | — | — | — | $250 – $250 |
| 5 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 6 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $248 | $248 | — | — | — | $248 – $248 |
| 7 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · outpatient | 1 | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 8 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL professional · fee schedule · inpatient | 1 | $139 | $139 | — | — | — | $139 – $139 |
| 9 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL professional · fee schedule · outpatient | 1 | $139 | $139 | — | — | — | $139 – $139 |
| 10 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · case rate · outpatient | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 11 | NYU Langone New York, NY case rate · both | 15 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 12 | NYU Langone Mineola, NY case rate · both | 15 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 13 | NYU Langone Brooklyn, NY case rate · both | 15 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 14 | NYU Langone New York, NY case rate · both | 15 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 15 | NYU Langone Hospital?Suffolk Patchogue, NY case rate · both | 15 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 16 | St Joseph Mercy Ann Arbor Ypsilanti, MI professional · fee schedule · inpatient | 1 | $116 | $116 | — | — | — | $116 – $116 |
| 17 | St Joseph Mercy Ann Arbor Ypsilanti, MI professional · fee schedule · outpatient | 1 | $116 | $116 | — | — | — | $116 – $116 |
| 18 | St Mary Medical Center Langhorne, PA professional · fee schedule · inpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 19 | St Mary Medical Center Langhorne, PA professional · fee schedule · outpatient | 1 | $125 | $125 | — | — | — | $125 – $125 |
| 20 | Ste. Genevieve County Memorial Hospital Ste. Genevieve, MO percent of total billed charges · outpatientfrom % of charges | 1 | $396 | $396 | — | — | — | $396 – $396 |
| 21 | UNIVERSITY OF MICHIGAN HEALTH Ann Arbor, MI professional · fee schedule · inpatient | 1 | $232 | $232 | — | — | — | $232 – $232 |
| 22 | UNIVERSITY OF MICHIGAN HEALTH Ann Arbor, MI professional · fee schedule · outpatient | 1 | $358 | $358 | — | — | — | $358 – $358 |
← Payers reporting CPT 28312 · Snapshot 20261112T181611Z-3fa9fb76