▸ Payer

optum health

Negotiated rates published by hospitals for optum health across 6 states. Data sourced from federally-mandated machine-readable files.

Hospitals

Procedures

States

Rate rows

1,705

Median neg. rate

$13,969

Top procedures for optum health

By number of hospitals reporting rates for this payer.

Procedure	Type	Code	Hospitals	Avg rate
Uterine & adnexa procedures w CC/MCC	MS-DRG	743	8	$28,569
Respiratory infections & inflammations w MCC	MS-DRG	177	8	$35,540
Kidney/UTI w/o MCC	MS-DRG	690	8	$17,474
COPD w/o CC/MCC	MS-DRG	192	8	$13,963
Heart failure & shock w MCC	MS-DRG	291	8	$40,058
Heart failure & shock w CC	MS-DRG	292	8	$20,641
Hip & femur procedures except major joint w MCC	MS-DRG	480	8	$51,801
OR procedure for obesity w CC	MS-DRG	620	8	$30,194
Cardiac arrhythmia w/o CC/MCC	MS-DRG	310	8	$14,221
Esophagitis/gastroenteritis w/o MCC	MS-DRG	392	8	$11,853
Laparoscopic cholecystectomy w/o CDE w CC	MS-DRG	419	8	$26,520
AMI discharged alive w CC	MS-DRG	281	8	$30,934
Chest X-ray single view	CPT	71045	6	$427.52
GI hemorrhage w/o CC/MCC	MS-DRG	379	4	$6,496.73
Major small/large bowel procedures w/o CC/MCC	MS-DRG	331	4	$15,288
Laparoscopic cholecystectomy w/o CDE w MCC	MS-DRG	418	4	$15,352
Laparoscopic cholecystectomy w/o CDE w/o CC/MCC	MS-DRG	420	4	$31,570
AMI discharged alive w MCC	MS-DRG	280	4	$15,205
Upper GI endoscopy diagnostic	CPT	43235	4	$1,779
Upper GI endoscopy with biopsy	CPT	43239	4	$1,929.12
Sigmoidoscopy diagnostic	CPT	45330	4	$1,927.1
Sigmoidoscopy with biopsy	CPT	45331	4	$2,538.95
Major joint replacement w MCC	MS-DRG	469	4	$29,309
Heart failure & shock w/o CC/MCC	MS-DRG	293	4	$5,733.99
Cardiac arrhythmia w MCC	MS-DRG	308	4	$11,430
Cardiac arrhythmia w CC	MS-DRG	309	4	$7,386
Colonoscopy with polyp removal	CPT	45385	4	$2,835.89
Simple pneumonia & pleurisy w/o CC/MCC	MS-DRG	195	4	$6,375.38
COPD w CC	MS-DRG	191	4	$8,424.35
GI hemorrhage w CC	MS-DRG	378	4	$9,523.39

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Lowest average negotiated rate across all procedures at this payer.

Hospital	City	ST	Avg neg. rate
Sharp Mesa Vista Hospital	—	—	$304.19
Sharp Mesa Vista Hospital	San Diego	CA	$304.19
Sharp Mary Birch Hospital for Women and Newborns	—	—	$11,156
Sharp Memorial Hospital-transplant	—	—	$11,156
Sharp Memorial Hospital	—	—	$11,156
Sharp Memorial Hospital	San Diego	CA	$11,156
Jersey Shore University Med Ctr	Neptune	NJ	$12,325
Jfk University Medical Center	Edison	NJ	$14,619
Hackensack University Medical Center	—	—	$14,619
Hackensack University Medical Center	Hackensack	NJ	$14,619

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States with hospitals publishing rates for optum health.

State	Hospitals	Avg rate
NJ	3	$13,854
CA	2	$10,448

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