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
ER-CL TX DSLOCATE TOE RQ/ANES
Low
$1
Average
$711
Median
$308
High
$1.5k
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
30 hospitals; the 90th percentile is 13.2× 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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34 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 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $102 | $102 | — | — | — | $102 – $102 |
| 2 | Chapman Global Medical Center Orange, CA facility · fee schedule · outpatient | 1 | $129 | $129 | — | — | — | $129 – $129 |
| 3 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $666 | $666 | — | — | — | $666 – $666 |
| 4 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL professional · fee schedule · outpatient | 1 | $118 | $118 | — | — | — | $118 – $118 |
| 5 | Community Memorial Hospital Ventura, CA facility · fee schedule · outpatient | 1 | $162 | $162 | — | — | — | $162 – $162 |
| 6 | Eisenhower Medical Center Rancho Mirage, CA fee schedule · both | 3 | $162 | $162 | — | — | — | $162 – $162 |
| 7 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $88 | $88 | — | — | — | $88 – $88 |
| 8 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · outpatient | 1 | $145 | $145 | — | — | — | $145 – $145 |
| 9 | Geisinger Wyoming Valley Wilkes-Barre, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 10 | Henry Ford Health Novi, MI other · outpatient | 1 | $151 | $151 | — | — | — | $151 – $151 |
| 11 | Henry Ford Health Twp, MI other · outpatient | 1 | $155 | $155 | — | — | — | $155 – $155 |
| 12 | Henry Ford Health Southfield, MI other · outpatient | 1 | $151 | $151 | — | — | — | $151 – $151 |
| 13 | Henry Ford Health Rochester, MI other · outpatient | 1 | $141 | $141 | — | — | — | $141 – $141 |
| 14 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · case rate · outpatient | 1 | $666 | $666 | — | — | — | $666 – $666 |
| 15 | Maple Grove Hospital Corporation Grove, MN facility · other · both | 1 | $224 | $224 | — | — | — | $224 – $224 |
| 16 | McLeod Health Dillon, SC fee schedule · both | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 17 | McLeod Health Cheraw, SC fee schedule · both | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 18 | McLeod Health Manning, SC fee schedule · both | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 19 | McLeod Health Florence, SC fee schedule · both | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 20 | McLeod Health Beach, SC fee schedule · both | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 21 | McLeod Health Loris, SC fee schedule · both | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 22 | McLeod Health River, SC fee schedule · both | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 23 | Mercy Hospital Logan County Inc Guthrie, OK facility · fee schedule · outpatient | 1 | $134 | $134 | — | — | — | $134 – $134 |
| 24 | NYU Langone New York, NY case rate · both | 15 | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 25 | NYU Langone Mineola, NY case rate · both | 15 | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
← Payers reporting CPT 28665 · Snapshot 20261113T090226Z-3ce6c0b8