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Hammertoe correction: what insurers pay

Straightening a bent toe joint. Commercial negotiated rates by hospital and market, next to Medicare for the same code.

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CPT 28285: Hammertoe Correction

1165 hospitals in 80 markets. National Medicare rate $3,343, surgery center $1,645.

MarketHospitals25th pctMedian75th pctLow–high
Alabama (statewide)13$3,158$3,900$4,244$2,673–$8,718
Alaska (statewide)3———$3,573–$15,112
Arizona (statewide)13$3,842$4,253$4,465$2,108–$11,826
Arkansas (statewide)8$2,509$3,006$3,841$2,330–$4,485
Atlanta GA10$5,324$5,531$5,531$5,324–$5,809
Austin TX13$2,628$4,863$4,863$2,628–$5,353
Boston MA11$4,452$5,031$5,714$3,000–$6,591
California (statewide)64$4,796$7,543$11,961$3,560–$13,120
Charlotte NC5$3,857$3,857$3,857$3,805–$3,857
Chicago IL7$4,977$5,636$7,295$3,751–$7,516
Cleveland OH11$3,328$3,902$5,554$2,453–$6,249
Colorado (statewide)15$4,579$5,782$6,606$3,185–$10,197
Columbus OH1———$11,769–$11,769
Connecticut (statewide)2———$7,414–$13,633
Dallas-Fort Worth TX12$5,449$5,574$6,730$5,023–$10,833
Delaware (statewide)1———$8,892–$8,892
Denver CO15$3,552$5,492$5,908$3,185–$7,200
Detroit MI15$2,795$3,708$5,058$2,795–$5,812
Florida (statewide)59$5,503$6,736$7,272$2,012–$15,595
Georgia (statewide)42$3,502$5,282$5,809$2,095–$17,296
Hawaii (statewide)5$4,456$4,774$5,144$3,368–$8,080
Houston TX19$4,336$4,708$4,807$4,144–$6,245
Idaho (statewide)15$3,188$4,428$7,829$2,977–$13,000
Illinois (statewide)26$4,150$5,507$7,295$2,880–$9,639
Indiana (statewide)36$4,335$7,311$15,170$1,905–$26,474
Indianapolis IN1———$8,718–$8,718
Iowa (statewide)23$4,340$5,178$7,309$1,953–$9,929
Kansas (statewide)19$3,595$4,056$5,266$2,250–$15,112
Kentucky (statewide)16$3,733$4,234$4,420$1,845–$5,710
Las Vegas NV2———$2,499–$3,010
Los Angeles CA17$5,214$6,102$8,330$4,792–$20,636
Louisiana (statewide)21$3,088$3,652$4,064$2,737–$9,482
Maine (statewide)17$13,295$14,927$15,435$3,465–$19,406
Maryland (statewide)1———$4,363–$4,363
Massachusetts (statewide)7$3,493$4,236$4,486$2,503–$5,100
Miami-Fort Lauderdale FL1———$6,262–$6,262
Michigan (statewide)25$3,396$3,583$3,856$1,645–$5,698
Minneapolis-St. Paul MN8$4,656$4,679$4,801$2,222–$6,072
Minnesota (statewide)14$4,679$8,045$10,310$4,209–$14,305
Mississippi (statewide)17$1,786$4,093$5,051$1,786–$12,864
Missouri (statewide)17$4,387$5,052$6,290$3,137–$6,897
Montana (statewide)5$6,181$6,562$6,814$4,056–$9,713
Nashville TN8$3,262$3,529$4,215$1,869–$6,688
Nebraska (statewide)11$6,065$8,645$8,645$2,499–$18,020
Nevada (statewide)5$2,318$2,499$6,228$2,318–$6,584
New Hampshire (statewide)6$8,809$10,474$11,260$6,251–$14,652
New Jersey (statewide)23$5,877$7,262$8,289$3,545–$11,208
New Mexico (statewide)9$4,379$6,447$10,160$3,083–$13,842
New York (statewide)32$4,041$4,935$7,011$2,531–$11,332
New York City8$3,963$4,939$7,688$3,913–$12,245
North Carolina (statewide)5$5,298$6,331$8,674$3,928–$9,044
North Dakota (statewide)5$5,470$5,613$5,716$5,176–$7,395
Ohio (statewide)39$3,508$6,862$9,414$1,596–$12,576
Oklahoma (statewide)11$5,040$6,702$7,410$1,613–$10,430
Oregon (statewide)8$8,308$9,591$11,997$7,348–$14,924
Pennsylvania (statewide)42$3,530$6,052$7,161$2,133–$16,920
Philadelphia PA11$4,617$4,904$6,462$4,096–$11,208
Phoenix AZ8$3,734$4,116$4,231$2,936–$4,231
Pittsburgh PA8$4,263$5,706$6,718$2,860–$8,166
Portland OR9$10,801$10,801$11,960$10,537–$11,960
Rhode Island (statewide)5$4,393$6,284$6,757$3,711–$7,600
Richmond VA3———$6,380–$7,051
Rio Grande Valley TX7$4,272$4,416$5,830$4,252–$14,797
Salt Lake City UT9$3,576$3,698$3,698$2,947–$3,819
San Antonio TX3———$3,960–$4,807
San Diego CA7$7,154$7,154$7,200$6,018–$7,760
San Francisco Bay Area CA4———$6,682–$22,041
Seattle-Tacoma WA16$8,488$9,090$11,697$8,396–$12,093
South Carolina (statewide)18$8,684$10,138$14,185$2,439–$14,603
South Dakota (statewide)5$5,205$5,830$5,938$5,017–$16,579
Tampa FL6$6,038$6,038$6,038$3,812–$10,426
Tennessee (statewide)26$3,117$3,389$4,497$2,218–$8,384
Texas (statewide)76$4,020$5,002$5,504$2,035–$20,580
Utah (statewide)7$3,060$3,576$3,637$2,947–$11,341
Vermont (statewide)1———$3,667–$3,667
Virginia (statewide)20$7,253$9,846$10,691$4,936–$12,413
Washington (statewide)16$6,079$9,318$9,686$1,851–$19,013
Washington DC8$5,822$5,822$5,956$5,079–$6,372
West Virginia (statewide)5$3,602$5,466$13,136$2,830–$21,783
Wisconsin (statewide)43$6,146$7,043$7,250$1,966–$12,908

Lowest and highest 12 hospital medians

HospitalMarketMedian across insurers× MedicareInsurersFile date
Nationwide Children'S HospitalOhio (statewide)$1,5960.5×12026-04-01
Newman Memorial HospitalOklahoma (statewide)$1,6130.5×12026-07-10
Helen Newberry Joy HospitalMichigan (statewide)$1,6450.5×12026-09-02
Ochsner Rush HospitalMississippi (statewide)$1,7860.6×22026-04-01
Ochsner Watkins HospitalMississippi (statewide)$1,7860.6×22026-04-01
Ochsner Laird HospitalMississippi (statewide)$1,7860.6×22026-04-01
Ochsner Scott RegionalMississippi (statewide)$1,7860.6×22026-04-01
Ochsner Stennis Memorial HospitalMississippi (statewide)$1,7860.6×22026-04-01
Oaklawn HospitalMichigan (statewide)$1,8290.6×22026-03-27
Jackson Purchase Medical CenterKentucky (statewide)$1,8450.6×12026-07-10
Lourdes Medical CenterWashington (statewide)$1,8510.5×12026-07-10
Ascension Saint Thomas RutherfordNashville TN$1,8690.6×12026-01-01
Mary Bridge Children'S HospitalWashington (statewide)$19,0135.0×52026-08-27
Mainehealth Lincoln HospitalMaine (statewide)$19,4066.0×12025-09-09
Parkview Wabash Hospital, IncIndiana (statewide)$20,3685.9×12026-09-01
Parkview Regional Medical CenterIndiana (statewide)$20,5805.9×12026-09-01
Parkview HospitalTexas (statewide)$20,5806.3×12026-09-01
Cedars-Sinai Medical CenterLos Angeles CA$20,6364.9×32025-11-26
Logan Regional Medical CenterWest Virginia (statewide)$21,7836.9×12026-04-01
Stanford Health CareSan Francisco Bay Area CA$22,0414.6×32026-04-01
Franciscan Health LafayetteIndiana (statewide)$22,4486.5×12026-01-01
Franciscan Health Crown PointIndiana (statewide)$25,2317.3×32026-01-01
Franciscan Health MunsterIndiana (statewide)$25,9657.5×32026-01-01
Franciscan Health Michigan CityIndiana (statewide)$26,4747.7×32026-01-01

Every hospital is on its state's page (linked in the market table) and in the interactive explorer.

Questions

How much do commercial insurers pay hospitals for hammertoe correction?

Across 1165 hospitals in 80 markets (metro areas and statewide) that post a usable dollar rate, the median commercial rate for CPT 28285, hospital outpatient is $5,504, 1.6× the same hospital's local Medicare base rate. The middle half of hospitals runs $3,986 to $7,458. Figures are each hospital's median across insurers, from its federal price-transparency file.

What does Medicare pay for hammertoe correction?

Medicare's national hospital outpatient rate for CPT 28285 is $3,343 and its surgery-center rate is $1,645, before local wage adjustment.

Which hospitals post the lowest and highest commercial rates for hammertoe correction?

Lowest medians: Nationwide Children'S Hospital ($1,596), Newman Memorial Hospital ($1,613), Helen Newberry Joy Hospital ($1,645). Highest: Franciscan Health Michigan City ($26,474), Franciscan Health Munster ($25,965), Franciscan Health Crown Point ($25,231). Coverage: every hospital whose price file we could read.