Hoag Orthopedic Institute
HOAG ORTHOPEDIC INSTITUTE in Irvine, CA charges 5.8x the Medicare reimbursement rate across 12 analyzed procedures, reflecting typical pricing patterns for specialized orthopedic facilities.
Irvine, CA 92618 · Acute Care Hospitals
About the analyst
Kevin Nyk analyzes hospital pricing data at BillRazor Research. He specializes in Medicare reimbursement patterns and chargemaster pricing across U.S. hospitals. Expertise: hospital pricing, Medicare rates, chargemaster analysis.
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Billing patterns — for-profit
For-profit hospitals in our dataset demonstrate distinct billing patterns, with 628 facilities showing an average markup of 7.8 times Medicare rates. These hospitals typically maintain higher charge structures across most service categories compared to non-profit and government facilities. Common patterns include substantial charges above benchmark rates for emergency services, surgical procedures, and diagnostic imaging. Patients should be aware that initial bills from for-profit hospitals often reflect chargemaster rates rather than negotiated insurance amounts. The billing structure frequently includes separate charges for facility fees, physician services, and ancillary services that may appear as multiple line items. Before receiving care, patients can request cost estimates and inquire about financial assistance programs, which are federally required at all hospital types. Understanding that insurance negotiations typically result in significantly lower actual payments than initial charges can help patients navigate the billing process more effectively when receiving care at for-profit facilities.
Pricing grade
D
High
Avg markup vs Medicare
5.79x
Charge / Medicare rate
Max markup
7.28x
Worst procedure
Procedures analyzed
12
With pricing data
Outlier procedures
0%
Above 90th percentile
Pricing grades reflect how this hospital's chargemaster (list) rates compare to Medicare reimbursement benchmarks within the same state. Grades measure pricing patterns only — not quality of care, patient outcomes, or clinical performance. A lower grade does not mean a hospital provides inferior care. Based on publicly available federal data. Not endorsed by or affiliated with any government agency.
| Procedure | Code | Gross charge | Cash price | Medicare | Markup |
|---|---|---|---|---|---|
| MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES | 483 | $132,928 | $66,464 | — | 7.3x |
| CERVICAL SPINAL FUSION WITHOUT CC/MCC | 473 | $115,333 | $57,667 | — | 6.4x |
| REVISION OF HIP OR KNEE REPLACEMENT WITH CC | 467 | $157,037 | $78,519 | — | 6x |
| MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC | 470 | $83,606 | $41,803 | — | 5.9x |
| REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC | 468 | $118,336 | $59,168 | — | 5.9x |
| HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC | 522 | $87,483 | $43,742 | — | 5.9x |
| BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC | 462 | $131,447 | $65,723 | — | 5.7x |
| CERVICAL SPINAL FUSION WITH CC | 472 | $124,170 | $62,085 | — | 5.6x |
| SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC | 460 | $150,529 | $75,264 | — | 5.6x |
| COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC | 455 | $191,038 | $95,519 | — | 5.2x |
| COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC | 454 | $244,213 | $122,106 | — | 5.2x |
| COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC | 453 | $353,559 | $176,780 | — | 4.9x |
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Pricing data from federal hospital transparency files and physician fee schedules. Last updated: . All data is publicly available under federal law.
FAQ — for-profit hospital billing
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Data: Federal hospital pricing data, updated annually. All data publicly available under federal law.
Methodology: Hospital gross charges divided by Medicare payment for the same DRG. A ratio of 3.0x means the hospital's listed price is 3 times what Medicare pays. Chargemaster rates are list prices — they are not what most insured patients pay. Grades measure pricing patterns only — not quality of care or clinical performance.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use