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
HC ORTHO EWH W JT CPF FIT&ADJUST
Rochester, MN
See all hospitals reporting HCPCS L3764 →Price type
Mayo Clinic’s median price of $1.1k is 22% above the median hospital's median price ($920), higher than 75% of the 1,050 hospitals reporting HCPCS L3764. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 18 payers, 121 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 | Blue Cross Blue Shield medicaid base apr drg only [1276] facility · percent of total billed charges · bothfrom % of charges | $246 | $246 | — | — | — | $246 – $246 |
| 2 | Blue Cross Blue Shield medicaid base apr drg only [1277] facility · percent of total billed charges · bothfrom % of charges | $246 | $246 | — | — | — | $246 – $246 |
| 3 | Healthpartners medicaid cah healthpartners [1174] facility · percent of total billed charges · bothfrom % of charges | $246 | $246 | — | — | — | $246 – $246 |
| 4 | Molina medicaid base apr drg only [1276] facility · percent of total billed charges · bothfrom % of charges | $246 | $246 | — | — | — | $246 – $246 |
| 5 | Ucare medicaid base apr drg only [1276] facility · percent of total billed charges · bothfrom % of charges | $246 | $246 | — | — | — | $246 – $246 |
| 6 | Ucare pps medicaid ucare [1184] facility · percent of total billed charges · bothfrom % of charges | $246 | $246 | — | — | — | $246 – $246 |
| 7 | UnitedHealthcare medicaid base apr drg only [1276] facility · percent of total billed charges · bothfrom % of charges | $246 | $246 | — | — | — | $246 – $246 |
| 8 | Medica medica medicaid [1244] facility · percent of total billed charges · bothfrom % of charges | $577 | $577 | — | — | — | $577 – $577 |
| 9 | Medica medica medicare advantage plan msho msc+ cap [167] facility · percent of total billed charges · bothfrom % of charges | $596 | $596 | — | — | — | $596 – $596 |
| 10 | Medica medicaid medica choice care msc+ [1175] facility · percent of total billed charges · bothfrom % of charges | $596 | $596 | — | — | — | $596 – $596 |
| 11 | Optum medica ma medicare advantage plan behavioral health [1350] facility · percent of total billed charges · bothfrom % of charges | $721 | $721 | — | — | — | $721 – $721 |
| 12 | Optum veteran affairs optum [1054] professional · fee schedule · outpatient | $876 | $876 | — | — | — | $876 – $876 |
| 13 | Ucare ucare essentia care medicare advantage plan [775] professional · fee schedule · outpatient | $876 | $876 | — | — | — | $876 – $876 |
| 14 | Blue Cross Blue Shield blue cross blue shield medicare advantage plan aco [815] professional · fee schedule · outpatient | $893 | $893 | — | — | — | $893 – $893 |
| 15 | Ucare ucare medicare advantage plan [643] professional · fee schedule · outpatient | $893 | $893 | — | — | — | $893 – $893 |
| 16 | Medica medica advantage solutions by county [1204] professional · fee schedule · outpatient | $902 | $902 | — | — | — | $902 – $902 |
| 17 | Blue Cross Blue Shield blue cross blue shield medicare advantage plan msho [226] professional · fee schedule · outpatient | $920 | $920 | — | — | — | $920 – $920 |
| 18 | Blue Cross Blue Shield blue cross blue shield medicare advantage plan ppo and hmo [1099] professional · fee schedule · outpatient | $920 | $920 | — | — | — | $920 – $920 |
| 19 | Medica medica dual solution msho medicare advantage plan [1004] professional · fee schedule · outpatient | $937 | $937 | — | — | — | $937 – $937 |
| 20 | Blue Cross Blue Shield pps medicaid bcbs [1146] facility · fee schedule · both | $945 | $945 | — | — | — | $945 – $945 |
| 21 | Blue Cross Blue Shield blue cross blue shield medicare advantage plan aco southern [1123] facility · percent of total billed charges · bothfrom % of charges | $946 | $946 | — | — | — | $946 – $946 |
| 22 | Blue Cross Blue Shield blue cross blue shield medicare advantage plan ppo [826] facility · percent of total billed charges · bothfrom % of charges | $946 | $946 | — | — | — | $946 – $946 |
| 23 | Medica medica advantage solution by county medicare advantage plan [793] facility · percent of total billed charges · bothfrom % of charges | $946 | $946 | — | — | — | $946 – $946 |
| 24 | Optum veteran affairs optum [1045] facility · percent of total billed charges · bothfrom % of charges | $946 | $946 | — | — | — | $946 – $946 |
| 25 | Ucare ucare connect+ medicare advantage plan [1116] facility · percent of total billed charges · bothfrom % of charges | $946 | $946 | — | — | — | $946 – $946 |
Last updated: Aug 14, 2026
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