▸ Payer

the health plan

Negotiated rates published by hospitals for the health plan across 8 states. Data sourced from federally-mandated machine-readable files.

Hospitals

Procedures

196

States

Rate rows

12,633

Median neg. rate

$742.5

Top procedures for the health plan

By number of hospitals reporting rates for this payer.

Procedure	Type	Code	Hospitals	Avg rate
Laparoscopic cholecystectomy w/o CDE w CC	MS-DRG	419	55	$12,988
Major small/large bowel procedures w CC	MS-DRG	330	55	$21,950
Major small/large bowel procedures w/o CC/MCC	MS-DRG	331	55	$15,828
Laparoscopic cholecystectomy w/o CDE w MCC	MS-DRG	418	55	$15,856
Major joint replacement w/o MCC	MS-DRG	470	55	$17,728
Septicemia or severe sepsis w MV 96+ hrs	MS-DRG	871	55	$18,391
Septicemia or severe sepsis w/o MV 96+ hrs	MS-DRG	872	55	$10,101
Heart failure & shock w MCC	MS-DRG	291	55	$12,632
Heart failure & shock w CC	MS-DRG	292	55	$8,668.51
Esophagitis/gastroenteritis w/o MCC	MS-DRG	392	55	$8,030.48
Kidney/UTI w/o MCC	MS-DRG	690	55	$8,046.93
Kidney/UTI w MCC	MS-DRG	689	55	$11,364
Cardiac arrhythmia w MCC	MS-DRG	308	55	$11,976
Cardiac arrhythmia w CC	MS-DRG	309	55	$7,532.08
Cardiac arrhythmia w/o CC/MCC	MS-DRG	310	55	$5,986
AMI discharged alive w MCC	MS-DRG	280	55	$15,543
AMI discharged alive w/o CC/MCC	MS-DRG	282	55	$7,486.74
Simple pneumonia & pleurisy w CC	MS-DRG	194	55	$8,241.61
Simple pneumonia & pleurisy w/o CC/MCC	MS-DRG	195	55	$6,492.38
Respiratory infections & inflammations w MCC	MS-DRG	177	55	$15,255
COPD w MCC	MS-DRG	190	55	$10,974
COPD w CC	MS-DRG	191	55	$8,720.8
COPD w/o CC/MCC	MS-DRG	192	55	$6,895.69
GI hemorrhage w CC	MS-DRG	378	55	$9,846.42
GI hemorrhage w/o CC/MCC	MS-DRG	379	55	$6,822.06
Major small/large bowel procedures w MCC	MS-DRG	329	55	$41,407
Major joint replacement w MCC	MS-DRG	469	53	$29,663
Hip & femur procedures except major joint w CC	MS-DRG	481	53	$19,583
Hip & femur procedures except major joint w/o CC/MCC	MS-DRG	482	53	$15,360
Hip & femur procedures except major joint w MCC	MS-DRG	480	53	$26,888

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Top 20 cheapest hospitals for the health plan

Lowest average negotiated rate across all procedures at this payer.

Hospital	City	ST	Avg neg. rate
Summers County ARH Hospital	—	—	$459.57
Summers County Arh	Hinton	WV	$459.57
Twin City Hospital	Dennison	OH	$873.05
Uh Geauga Medical Center	Chardon	OH	$1,303.36
Uh Regional Hospitals	Richmond Heights	OH	$1,303.36
University Hospitals Regional Hospitals - Geauga Medical Center	—	—	$1,303.36
Tug Valley Arh	South Williamson	KY	$2,198.32
Santa Cruz Valley Regional Hospital	Green Valley	AZ	$2,198.32
Adena Pike Medical Center	—	—	$2,378.97
Adena Regional Medical Center	Chillicothe	OH	$2,378.97
Adena Greenfield Medical Center	—	—	$2,378.97
Fayette County Memorial Hosp	Washington Court House	OH	$2,378.97
University Hospitals Samaritan Medical Center	—	—	$2,643.18
Uh Samaritan Medical Center	Ashland	OH	$2,643.18
East Adams Rural Hospital	Ritzville	WA	$2,910.59
San Antonio Regional Hospital	Upland	CA	$2,910.59
Beckley ARH Hospital	—	—	$2,910.59
Beckley Arh	Beckley	WV	$2,910.59
University Hospitals Beachwood Medical Center	—	—	$3,472.95
University Hospitals Tripoint Medical Center	—	—	$3,594.83

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States covered

States with hospitals publishing rates for the health plan.

State	Hospitals	Avg rate
OH	23	$4,437.5
CA	2	$10,406
WV	2	$1,925.38
AZ	1	$2,198.32
WA	1	$2,910.59
MA	1	$12,258
KY	1	$2,198.32
LA	1	$3,597.04

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