California / Hoag Orthopedic Institute
CMS certification 050769 · Irvine, CA · 2 entries in CMS's price-transparency list
Hoag Orthopedic Institute: charges and Medicare payments
Hoag Orthopedic Institute reported 771 Medicare inpatient stays across 17 DRGs in 2024. Across them it charged 4.81 times what it was paid — mid-range in California, number 144 of 247 hospitals with at least 100 stays (state median 5.18×, national 4.15×). Its most frequent stay was DRG 470, Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC: 303 stays at an average charge of $85,751, 8% below the national average. It also billed 1,604 outpatient services, charging 5.06 times what Medicare paid.
- 1Medicare inpatient stays 771
- 2Charge ÷ paid, inpatient 4.81×
- 3Rank in CA (highest ratio = 1) 144 of 247
- 4CMS price-transparency actions 2
Inpatient stays
For the 17 DRGs that can be compared with the national average, Hoag Orthopedic Institute charged more than the national average in 5 (29%). Payments follow Medicare's rates, so they usually vary far less than charges.
| DRG | Stays | Avg charge | vs US | Avg paid |
|---|---|---|---|---|
| 470 Major Hip and Knee Joint Replacement or Reattachment of... | 303 | $85,751 | -8% | $17,493 |
| 460 Spinal Fusion except Cervical without MCC | 57 | $146,728 | -14% | $35,754 |
| 455 Combined Anterior and Posterior Spinal Fusion without CC/MCC | 55 | $193,091 | -5% | $45,261 |
| 454 Combined Anterior and Posterior Spinal Fusion with CC | 52 | $279,504 | 0% | $57,080 |
| 483 Major Joint or Limb Reattachment Procedures of Upper... | 51 | $147,991 | +17% | $23,031 |
| 468 Revision of Hip or Knee Replacement without CC/MCC | 43 | $144,051 | +16% | $25,325 |
| 472 Cervical Spinal Fusion with CC | 42 | $127,819 | -11% | $27,320 |
| 522 Hip Replacement with Principal Diagnosis of Hip Fracture... | 31 | $100,602 | -2% | $18,581 |
| 467 Revision of Hip or Knee Replacement with CC | 24 | $180,851 | +15% | $35,571 |
| 427 Multiple Level Combined Anterior and Posterior Spinal Fusion... | 19 | $250,722 | -27% | $64,153 |
| 402 Single Level Combined Anterior and Posterior Spinal Fusion... | 16 | $201,535 | +7% | $35,470 |
| 469 Major Hip and Knee Joint Replacement or Reattachment of... | 15 | $107,989 | -28% | $25,690 |
| 462 Bilateral or Multiple Major Joint Procedures of Lower... | 14 | $126,507 | -9% | $27,756 |
| 451 Single Level Spinal Fusion except Cervical without MCC | 13 | $131,089 | -13% | $29,741 |
| 473 Cervical Spinal Fusion without CC/MCC | 13 | $130,075 | +13% | $23,076 |
| 457 Spinal Fusion except Cervical with Spinal Curvature,... | 12 | $233,970 | -19% | $55,541 |
| 520 Back and Neck Procedures except Spinal Fusion without CC/MCC | 11 | $65,024 | -17% | $13,201 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 5 Musculoskeletal Procedures | 1,238 | $69,835 | $15,979 |
| Level 6 Musculoskeletal Procedures | 252 | $115,075 | $22,852 |
| Level 4 Musculoskeletal Procedures | 100 | $49,022 | $8,721 |
| Level 1 Nerve Procedures | 14 | $12,671 | $2,374 |
Against the California average
For Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC (DRG 470), Hoag Orthopedic Institute charged $85,751 on average, 38% less than the California average of $137,972, and was paid $17,493 against a state average of $21,800. For Spinal Fusion except Cervical without MCC (DRG 460), Hoag Orthopedic Institute charged $146,728 on average, 41% less than the California average of $250,434, and was paid $35,754 against a state average of $44,974. For Combined Anterior and Posterior Spinal Fusion without CC/MCC (DRG 455), Hoag Orthopedic Institute charged $193,091 on average, 33% less than the California average of $288,077, and was paid $45,261 against a state average of $53,223. For Combined Anterior and Posterior Spinal Fusion with CC (DRG 454), Hoag Orthopedic Institute charged $279,504 on average, 32% less than the California average of $412,133, and was paid $57,080 against a state average of $76,337. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $69,835 was 36% below the state average of $109,149. For Level 6 Musculoskeletal Procedures (outpatient APC 5116), its average charge of $115,075 was 13% below the state average of $132,087. For Level 4 Musculoskeletal Procedures (outpatient APC 5114), its average charge of $49,022 was 29% below the state average of $69,476. For Level 1 Nerve Procedures (outpatient APC 5431), its average charge of $12,671 was 35% below the state average of $19,391.
Price-transparency record
CMS's enforcement list records these actions for a hospital named Hoag Orthopedic Institute in Irvine, CA, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Met Requirements — 2025-09-16 (CMS case 6656)
- Warning Notice — 2026-06-18 (CMS case 7938)
A warning notice or corrective-action request is not a finding of wrongdoing; "Met Requirements" and closure notices record that CMS's review ended. Matched to this hospital by exact name, city and state.
Charges are the hospital's list prices averaged over its 2024 Medicare cases; payments are what those cases actually brought in. Neither is what you will pay. For a planned procedure, ask the hospital for its price estimate or, if you are uninsured or self-paying, a good-faith estimate.
Sources: CMS Medicare Inpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Hospital Price Transparency Enforcement Activities and Outcomes, July 2026. Checked 2026-10-24. Methodology.