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
ORTHO L0633 195X-254
Mt Shasta, CA
See all hospitals reporting HCPCS L0633 →Price type
Dignity Health’s median price of $784 is 117% above the median hospital's median price ($361), higher than 94% of the 887 hospitals reporting HCPCS L0633. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 24 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Aetna medicare|all plans fee schedule · outpatient | $229 | $229 | — | — | — | $229 – $229 |
| 2 | Anthem medicare|all plans fee schedule · outpatient | $229 | $229 | — | — | — | $229 – $229 |
| 3 | Blue Cross Blue Shield medicare|all plans fee schedule · outpatient | $229 | $229 | — | — | — | $229 – $229 |
| 4 | Humana medicare|all plans fee schedule · outpatient | $229 | $229 | — | — | — | $229 – $229 |
| 5 | Kaiser medicare|all plans fee schedule · outpatient | $229 | $229 | — | — | — | $229 – $229 |
| 6 | UnitedHealthcare medicare|all plans fee schedule · outpatient | $229 | $229 | — | — | — | $229 – $229 |
| 7 | Anthem medicaid|all plans fee schedule · inpatient | $239 | $239 | — | — | — | $239 – $239 |
| 8 | Anthem medicaid|all plans fee schedule · outpatient | $245 | $245 | — | — | — | $245 – $245 |
| 9 | Cigna commercial|all other plans fee schedule · inpatient | $784 | $784 | — | — | — | $784 – $784 |
| 10 | Cigna commercial|all other plans fee schedule · outpatient | $784 | $784 | — | — | — | $784 – $784 |
| 11 | Cigna commercial|ppo fee schedule · inpatient | $784 | $784 | — | — | — | $784 – $784 |
| 12 | Cigna commercial|ppo fee schedule · outpatient | $784 | $784 | — | — | — | $784 – $784 |
| 13 | UnitedHealthcare commercial|hmo fee schedule · inpatient | $822 | $822 | — | — | — | $822 – $822 |
| 14 | UnitedHealthcare commercial|hmo fee schedule · outpatient | $822 | $822 | — | — | — | $822 – $822 |
| 15 | Aetna commercial|all other plans fee schedule · outpatient | $832 | $832 | — | — | — | $832 – $832 |
| 16 | Aetna commercial|hmo fee schedule · outpatient | $832 | $832 | — | — | — | $832 – $832 |
| 17 | Aetna commercial|ppo fee schedule · outpatient | $832 | $832 | — | — | — | $832 – $832 |
| 18 | Aetna commercial|all other plans fee schedule · inpatient | $841 | $841 | — | — | — | $841 – $841 |
| 19 | Aetna commercial|hmo fee schedule · inpatient | $841 | $841 | — | — | — | $841 – $841 |
| 20 | Aetna commercial|ppo fee schedule · inpatient | $841 | $841 | — | — | — | $841 – $841 |
| 21 | UnitedHealthcare commercial|all other plans fee schedule · inpatient | $841 | $841 | — | — | — | $841 – $841 |
| 22 | UnitedHealthcare commercial|all other plans fee schedule · outpatient | $841 | $841 | — | — | — | $841 – $841 |
| 23 | MultiPlan commercial|all plans fee schedule · inpatient | $937 | $937 | — | — | — | $937 – $937 |
| 24 | MultiPlan commercial|all plans fee schedule · outpatient | $937 | $937 | — | — | — | $937 – $937 |
Last updated: Feb 28, 2026
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