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Short Term Acute Care HospitalProprietary

Hoag Orthopedic Institute

Hoag Memorial Hospital Presbyterian · Irvine, CA

16250 Sand Canyon Avenue, Irvine, CA 92618(949) 727-5000

Not rated by CMS

CMS star rating

70

Beds

1,738

Inpatient discharges a year

$158.5M

Net patient revenue a year

About this hospital

Hoag Orthopedic Institute is a 70-bed proprietary hospital in Irvine, CA, affiliated with Hoag Memorial Hospital Presbyterian.

CCN
050769
NPI
1982927877
Website
hoag.org
Health system
Hoag Memorial Hospital Presbyterian
Teaching
No Medicare-funded residents
County
Orange County
Metro area
Los Angeles-Long Beach-Anaheim, CA MSA
Medicare contractor
Jurisdiction E, Noridian Healthcare Solutions (01011)
In Medicare since
2010
Last CMS survey
2018

Prices for common services

The 24 services Hoag Orthopedic Institute most likely performs, ranked by likely volume and what it is paid. Each service names one insurer. * marks hidden insurer names; A, B and C rank the remaining rates from low to high and reset for each service.

Book a demo to see hidden insurer names, more payer rates, and hospital data, or start a free trial.

Medicine & Surgery · Inpatient

Major lower-extremity joint replacement without MCC

MS-DRG 470

$23,326 - $43,891

from 2 insurers · median $33,608

Anthem / Blue Shield$43,891
Insurer A*$23,326
Medicare $13,083Nearby hospitals $43,28922% below nearby hospitals

265 Medicare discharges for this DRG in CMS hospital data

Medicine & Surgery · Inpatient

Spinal fusion except cervical without MCC

MS-DRG 460

$85,149

negotiated rate

Anthem / Blue Shield$85,149
Medicare $27,862

78 Medicare discharges for this DRG in CMS hospital data

Digestive procedures

Upper GI endoscopy with biopsy

CPT 43239

$6,066 - $9,582

from 3 insurers · median $6,250

Aetna$9,582
Insurer A*$6,066
Insurer B*$6,250
Medicare $1,199Nearby hospitals $1,616287% above nearby hospitals

Common here, based on CMS Medicare volume

Digestive procedures

Colonoscopy with biopsy

CPT 45380

$5,487 - $9,582

from 3 insurers · median $6,066

Aetna$9,582
Insurer A*$5,487
Insurer B*$6,066
Medicare $1,582

Common here, based on CMS Medicare volume

How the insurers pay at Hoag Orthopedic Institute

Median rate as a percent of Medicare across the outpatient services above, and how many services sit above or below the same insurer's median at nearby hospitals. * marks hidden insurer names. These table labels track the same insurers across services; the labels on each service card reset.

InsurerServicesMedian % of MedicareAbove nearbyBelow nearby
Insurer A*24
409%
70
Insurer B*20
364%
05
Insurer C*15
334%
20
Insurer D*8
305%
02

How we chose these services: 5 appear in this hospital's own Medicare claims, 11 are common here based on CMS Medicare volume, and 8 are typical for the service lines it reports to CMS. Rates come from insurer and hospital price transparency files as of October 2026. Rates under a quarter of Medicare or over 20 times Medicare are left out as likely physician-fee rows or file errors. Book a demo to see all 300 CMS shoppable services for Hoag Orthopedic Institute, or start a free trial.

Insurance Accepted

Acceptance varies by plan and service. Confirm coverage with your insurer or the hospital's billing department.

Medicare

More about this hospital

  • Quality

    Not rated by CMS

    • No Medicare readmissions penalty
    See quality ratings

  • Doctors and services

    Accredited by DNV

    • No Medicare-funded residents
    • 23 services
    • 237 affiliated clinicians
    See doctors and services

  • Finances

    $158.5M net patient revenue

    • Operating margin on patient care 26.9%
    • $258,739 unreimbursed and uncompensated care
    • $45.5M net income
    See finances

  • Ownership and leadership

    Owned by Hoag Memorial Hospital Presbyterian

    • Private (for profit)
    • Kim Mikes, chief executive
    See ownership and leadership

Tax IDs and NPIs insurers list

The employer identification numbers (EINs) health plans and networks list for Hoag Orthopedic Institute in the in-network rate files they publish, with the organization NPIs billed under each.

Tax ID (EIN)Plans and networks listing itOrganization NPIs
61-1588294Hoag Orthopedic Institute LLC50Aetna, Cigna, United Healthcare (incl Optum, Rocky Mountain, Health Plan of Nevada, Sierra Health), Allied Benefit Systems, Aspirus Health Plan and 45 more1982927877 Hoag Orthopedic Institute LLC

Source: PayerPrice analysis of insurers' Transparency in Coverage in-network files. An EIN can cover several hospitals and clinics in a health system, and insurers sometimes list other organizations' NPIs under it.

Location

16250 Sand Canyon Avenue, Irvine, CA 92618

(949) 727-5000

Get directions

Frequently asked questions

About Hoag Orthopedic Institute's rates and hospital price transparency.

How much does an MRI cost at Hoag Orthopedic Institute?

For MRI brain before and after contrast (CPT 70553), published negotiated rates at Hoag Orthopedic Institute range from $583 to $3,710 across 3 insurers. Cigna's rate is $1,049. The median at nearby comparable hospitals is $948. What a patient pays depends on their plan's deductible, coinsurance and network status.

How much does a CT scan cost at Hoag Orthopedic Institute?

For CT abdomen and pelvis with contrast (CPT 74177), published negotiated rates at Hoag Orthopedic Institute range from $583 to $1,210 across 3 insurers. Cigna's rate is $1,078. The median at nearby comparable hospitals is $917. What a patient pays depends on their plan's deductible, coinsurance and network status.

How much does a colonoscopy cost at Hoag Orthopedic Institute?

For Colonoscopy with biopsy (CPT 45380), published negotiated rates at Hoag Orthopedic Institute range from $5,487 to $9,582 across 3 insurers. Aetna's rate is $9,582. What a patient pays depends on their plan's deductible, coinsurance and network status.

How much does a mammogram cost at Hoag Orthopedic Institute?

For Screening mammography, bilateral (CPT 77067), published negotiated rates at Hoag Orthopedic Institute range from $148 to $490 across 3 insurers. Anthem Blue Cross / Blue Shield of CA's rate is $490. What a patient pays depends on their plan's deductible, coinsurance and network status.

How much does hip or knee replacement cost at Hoag Orthopedic Institute?

For Major lower-extremity joint replacement without MCC (MS-DRG 470), published negotiated rates at Hoag Orthopedic Institute range from $23,326 to $43,891 across 2 insurers. Anthem Blue Cross / Blue Shield of CA's rate is $43,891. The median at nearby comparable hospitals is $43,289. What a patient pays depends on their plan's deductible, coinsurance and network status.

Is Hoag Orthopedic Institute a teaching hospital?

CMS reports no Medicare-funded interns or residents at Hoag Orthopedic Institute for fiscal year 2027.

Does Medicare penalize Hoag Orthopedic Institute for readmissions?

No. Hoag Orthopedic Institute has no Hospital Readmissions Reduction Program penalty in fiscal year 2027.

What are the most common Medicare inpatient stays at Hoag Orthopedic Institute?

In 2024, the most common were major hip and knee joint replacement or reattachment of lower extremity without mcc (303 discharges), spinal fusion except cervical without mcc (57 discharges), combined anterior and posterior spinal fusion without cc/mcc (55 discharges).

What is Hoag Orthopedic Institute's case mix index?

Hoag Orthopedic Institute's Medicare case mix index is 3.24 for fiscal year 2027, higher than 98% of hospitals paid under the inpatient prospective payment system.

How many patients does Hoag Orthopedic Institute admit?

Hoag Orthopedic Institute reported 1,738 inpatient discharges and 3,967 inpatient days from Jan 1, 2025 to Dec 31, 2025.

For hospital finance and compliance teams

Running price transparency at a hospital like this one?

The data on this page comes from the files hospitals and payers publish. We help hospitals publish theirs correctly, and take a fresh look at their chargemaster.

Compliance MRF

Publish a CMS-compliant machine-readable file

We turn your chargemaster and payer contracts into the CMS template file, then keep it current as rates change.

CMS v3 example: standard_charge_information[0]
{
  "description": "MRI of brain (no contrast)",
  "code_information": [
    { "code": "611", "type": "RC" },
    { "code": "70551", "type": "CPT" }
  ],
  "standard_charges": [{
    "setting": "outpatient",
    "minimum": 250,
    "maximum": 400,
    "gross_charge": 1200,
    "discounted_cash": 1080,
    "payers_information": [
      {
        "payer_name": "Platform Health Insurance",
        "plan_name": "PPO",
        "methodology": "fee schedule",
        "standard_charge_dollar": 400
      },
      {
        "payer_name": "Region Health Insurance",
        "plan_name": "HMO",
        "methodology": "fee schedule",
        "standard_charge_dollar": 250
      }
    ]
  }]
}
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  • cms-hpt.txt file and homepage footer link
  • Refreshed when your contracts change
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Your chargemaster sets the gross charge on every claim, and many payer contracts base payment on it through percent-of-charge, lesser-of and stop-loss terms. We audit it line by line and show how your charges and negotiated rates compare with peer hospitals before your next negotiation.

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CodingPricingPayer contractsCompliance
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