Negotiated-Rate Comparison Brief — Five Common Procedures, Tulare County, California

Sample brief — ForTre Partners Health Care Infrastructure. Produced November 6, 2026, from the two hospitals' own published price-transparency files; no other data was used. Published as a sample of the Negotiated Rate Brief, so a buyer can judge the method — sources, filters, and caveats included — before commissioning one.

Buyer question this brief answers: For five common, comparable procedures, what do the hospitals in one California county actually publish as their payer-negotiated rates — and how far apart are they?

County: Tulare County, CA. Hospitals with usable public files: Kaweah Health Medical Center (Visalia) and Sierra View Medical Center (Porterville) — 2 of the county's 3 general acute care hospitals. The third, Adventist Health Tulare, publishes through a vendor portal that does not expose a directly downloadable file (see Coverage Note); it is excluded and its absence is a stated limitation, not a silent gap.

Executive summary

The two hospitals price the same work very differently, and the direction of the gap flips by procedure. Sierra View's median commercial rate for knee arthroscopy ($4,208.34) is 4.6× Kaweah's ($910.74). Kaweah's median commercial rate for diagnostic colonoscopy ($2,722.94) is 2.3× Sierra View's ($1,196.08). For uncomplicated vaginal delivery the two are close (Kaweah median $7,889.00; Sierra View $7,970.59).
The same payer pays the two hospitals very different amounts. Aetna's published rate for a level-5 emergency department visit is $3,328.00 at Kaweah and $1,149.00 at Sierra View — a 2.9× gap for the same code inside one county. Health Net's published delivery rate (MS-DRG 807) runs the other way: $7,649.00 at Kaweah, $10,122.65 (median of two published plan rows) at Sierra View.
A large share of what the files call "negotiated rates" is not expressed in dollars at all. Of 331 rate rows for these procedures in the applicable settings, 47 (14%) are percentage-of-charges or algorithm formulas (e.g., "90 percent of total billed charges") that cannot be converted to dollars from the file. They are counted and reported, never converted.
Both files contain values that cannot be real transaction prices — a $0.01 "rate" published by Sierra View for three procedures, a $83.63 published MRI rate at Kaweah, and fee-schedule component amounts mixed into facility rate tables. This brief screens them with stated rules (Methodology) and flags rather than hides the rest.
The files disagree with themselves in ways a reader must know: Kaweah's published gross charge for knee arthroscopy ($1,093.00) is below several of its own published negotiated rates for the same code; Kaweah's "discounted cash price" equals its full gross charge on every outpatient procedure examined (no cash discount is actually published); Sierra View applies a flat 30% cash discount where it publishes both figures.

Sources

Hospital	File (as published by the hospital)	File date in file metadata	Format	Size
Kaweah Health Medical Center, Visalia (Kaweah Delta Health Care District)	`941534475-1588663769_kaweah-health-medical-center_standardcharges.csv`, at https://www.kaweahhealth.org/sites/default/files/images/941534475-1588663769_kaweah-health-medical-center_standardcharges.csv (located via the hospital's CMS locator file, https://www.kaweahhealth.org/sites/default/files/cms-hpt.txt; price-transparency page: https://www.kaweahhealth.org/chargemaster-access/chargemaster/)	last_updated_on 2026-07-14 (HTTP Last-Modified Jul 15, 2026)	CSV, CMS schema v3.0.0, "wide" payer-column encoding	29,555,919 bytes; 25,670 item rows
Sierra View Medical Center, Porterville (Sierra View Local Health Care District)	`941397461_sierra-view-local-health-care-district_standardcharges.csv`, via the hospital's download endpoint https://sierraview.pt.panaceainc.com/MRFDownload/sierraview/medicalcenter (located via https://www.sierra-view.com/cms-hpt.txt; page: https://www.sierra-view.com/patients-visitors/price-transparency-and-charge-master/)	last_updated_on 2026-04-01; as_of_date 2026-01-01	CSV, CMS schema v3.0.0, "tall" one-row-per-payer encoding	103,213,229 bytes; 277,517 rows

Files accessed and downloaded November 6, 2026. Both files are the hospitals' own CMS-required price-transparency publications. Sierra View's file is roughly seven months older than Kaweah's at access; rate comparisons inherit that staleness difference (see Caveats).

Coverage note — Adventist Health Tulare. Tulare County's third general acute care hospital publishes its price-transparency material through a vendor portal (PARA/HCFS Data Solutions, https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbAHTTULARECA). On November 6, 2026 that portal returned a server error to a direct request and no direct machine-readable file link could be extracted from the hospital's price-transparency page (https://www.adventisthealth.org/patients-and-visitors/price-transparency/); the system's cms-hpt.txt locator (https://www.adventisthealth.org/cms-hpt.txt) returned HTTP 403. No Adventist Health Tulare figures appear in this brief.

Procedure 1 — Diagnostic colonoscopy (CPT 45378; outpatient)

Why this procedure: high-volume, elective, shoppable, and coded identically everywhere; the classic price-transparency test case. Sierra View also publishes the Medicare screening analogue (HCPCS G0121), shown alongside.

Measure (facility rates, outpatient)	Kaweah (Visalia)	Sierra View (Porterville)
Gross charge	$3,039.00	not published for this code
Discounted cash price	$3,039.00 (= gross; no discount published)	not published for this code
Commercial negotiated rates, n	12	9
Commercial min / median / max	$1,309.24 / $2,722.94 / $4,948.00	$295.23 / $1,196.08 / $1,841.96
Medicare-linked median (n)	$1,202.12 (5)	$1,196.08 (1)
De-identified min–max published by hospital	$1,196.08 – $4,948.00	$257.44 – $1,841.96

Findings: Kaweah's commercial median is 2.3× Sierra View's. Sierra View's commercial median ($1,196.08) is identical to its G0121 screening median ($1,196.08, n=6) and recurs across payers — a benchmark-shaped value, not a spread of independently negotiated amounts (see Cross-cutting findings). Shared-payer check (Health Net, name-normalized): Kaweah $2,710.79 vs Sierra View $1,196.08.

Procedure 2 — MRI, lumbar spine, without contrast (CPT 72148; outpatient)

Why: high-volume imaging with wide documented price dispersion; a standard employer/union cost concern.

Measure	Kaweah	Sierra View
Gross charge	$4,119.00	$3,549.00
Discounted cash price	$4,119.00 (= gross)	$2,484.30 (exactly 70% of gross)
Commercial negotiated rates, n (retained basis)	22	20
Commercial min / median / max	$83.63 † / $985.86 / $3,707.10	$472.60 / $2,697.24 / $3,194.10
Medicare-linked median (n)	$307.65 (10)	— (sole Medicare-linked row flagged)
De-identified min–max	$83.63 – $4,693.95	$186.00 – $472.60 ‡

† Kaweah's $83.63 minimum is not a plausible full facility price for this procedure; it is retained in the table because no stated rule removes it, and flagged here. ‡ Sierra View's published de-identified range and its fee-schedule cluster sit far below its retained negotiated cluster — see the basis warning below.

Basis warning (read before citing any MRI figure): Sierra View publishes two distinct rate bases for this code. Eleven payer rows carry methodology "Fee Schedule" at $186.00–$368.26; twenty rows carry negotiated/other bases at $472.60–$3,194.10 (median $2,697.24). The table above uses the negotiated cluster and flags the fee-schedule cluster (Appendix A, † rows). Which basis governs a given claim cannot be determined from the file. Kaweah publishes a single blended set (median $985.86). Any one-number MRI comparison between these hospitals is basis-dependent; this brief reports both bases rather than choosing silently. The Sensitivity Note shows this is also the procedure where the zero-volume ghost screen reverses the comparison's direction.

Shared-payer checks: Aetna — Kaweah $1,289.87 vs Sierra View $2,174.00 (Sierra figure from its fuller published set; within the retained negotiated cluster Aetna does not appear at Sierra View — see Appendix A). Health Net — Kaweah $1,898.62 (median of published plan rows) vs Sierra View $733.16 on the same mixed-basis caveat.

Procedure 3 — Knee arthroscopy with meniscectomy (CPT 29881; outpatient)

Why: common elective orthopedic surgery; a frequent reference-pricing candidate.

Measure	Kaweah	Sierra View
Gross charge	$1,093.00 ⚠	not published for this code
Discounted cash price	$1,093.00 (= gross)	not published for this code
Commercial negotiated rates, n	10	6
Commercial min / median / max	$662.36 / $910.74 / $5,234.65	$3,787.51 / $4,208.34 / $6,480.84
Medicare-linked median (n)	$4,208.34 (5)	$4,208.34 (1)
De-identified min–max	$655.80 – $5,234.65	$750.40 – $6,480.84

⚠ Internal inconsistency at Kaweah: the published gross charge ($1,093.00) is below five of Kaweah's own published negotiated rates for this code, up to $5,234.65. A negotiated rate cannot exceed the charge it is negotiated from; Kaweah's 29881 row therefore appears to carry a charge basis that does not match the rate rows (possibly a component line). Kaweah's 29881 figures are reported as published and should be treated as unreliable for cross-hospital comparison; Sierra View's median ($4,208.34) is 4.6× Kaweah's as-published median, and that ratio should not be quoted without this note. Three Sierra View payer rows at an identical $551.00 "Fee Schedule" were flagged out of its median (Appendix A).

Shared-payer check (Health Net): Kaweah $974.96 vs Sierra View $4,208.34 — same caveat as above.

Procedure 4 — Emergency department visit, level 5 (CPT 99285; level 4 / 99284 alongside)

Why: among the highest-volume facility charges in any county; level-5 is the most severe non-critical ED tier and the usual focus of ED fee scrutiny. Facility component only, as published.

Measure	Kaweah	Sierra View
Gross charge (99285)	$4,094.00	$2,298.00
Discounted cash price	$4,094.00 (= gross)	$1,608.60 (70% of gross)
Commercial n	22	13
Commercial min / median / max (99285)	$266.76 / $1,632.00 / $3,684.60	$765.95 / $1,179.57 / $2,068.20
Commercial median, 99284 (n)	$1,452.25 (22)	$858.20 (13)
Medicare-linked median (99285) (n)	$767.88 (10)	$765.95 (1)
De-identified min–max (99285)	$266.76 – $4,094.00	$765.95 – $2,068.20

Findings: Kaweah's ED facility medians run ~1.4× (level 5) and ~1.7× (level 4) Sierra View's, on a gross charge roughly 1.8× Sierra View's. The cleanest like-for-like evidence is payer-matched: Aetna pays $3,328.00 at Kaweah vs $1,149.00 at Sierra View for 99285 (2.9×), and $2,089.00 vs $613.00 for 99284 (3.4×). Health Net: $1,986.48 vs $765.95 (99285, medians of published plan rows). Two Sierra View Health Net rows ($72.18 / $114.13, "Fee Schedule") were flagged as component-basis amounts and excluded from its medians (Appendix A).

Procedure 5 — Vaginal delivery (MS-DRG 807, without CC/MCC; 806/805 alongside)

Why: the most common inpatient admission in the United States; the uncomplicated tier (807) is the comparable unit. Case rates, inpatient.

Measure	Kaweah	Sierra View
Gross / cash	not published for DRG items	not published for DRG items
Commercial n (807)	6	4
Commercial min / median / max (807)	$1,650.00 § / $7,889.00 / $9,106.00	$7,970.59 / $7,970.59 / $12,274.71
Commercial median, 806 (with CC)	$7,649.00 (n=7)	$8,865.37 (n=4)
Commercial median, 805 (with MCC)	$7,889.00 (n=6)	$12,511.74 (n=4)
Medicare-linked median (807) (n)	$5,972.00 (3)	$7,970.59 (1)
De-identified min–max (807)	$1,650.00 – $9,106.00	$7,970.59 – $12,274.71

§ One Kaweah payer (First Health) publishes $1,650.00 with methodology "other" for all three delivery DRGs — implausible as a full facility case rate; retained and flagged here. One further Kaweah payer pays DRG 807 per diem ($4,422.00, Cigna HMO); per-diem dollars are excluded from case-rate statistics (Rule F7) because a per-day figure is not a case price.

Findings: (1) The two hospitals' uncomplicated-delivery medians are near-identical ($7,889.00 vs $7,970.59) — the only procedure family in this brief where they converge. (2) Severity gradient: Sierra View's medians rise with severity (807: $7,970.59 → 806: $8,865.37 → 805: $12,511.74). Kaweah's do not ($7,889 / $7,649 / $7,889) — for its two largest commercial payers Kaweah publishes the same rate ($8,400.00 Blue Shield HMO; $9,106.00 UHC) across all three severity tiers, i.e., a single maternity case rate regardless of complications. (3) Sierra View repeats one identical case rate, $7,970.59, across four different payers for DRG 807 — again a template-shaped value. (4) Delivery is where the percentage problem concentrates: 16 of the 47 non-dollar rows in this study are delivery rows (e.g., "100 percent of total billed charges" at Kaweah; 70–90% of charges at Sierra View), and since neither hospital publishes a gross charge for DRG items, those contracts' dollar value cannot even be estimated from the files.

Cross-cutting findings

Cash price ≠ discount at Kaweah. For every outpatient procedure examined, Kaweah's published discounted cash price equals its gross charge to the cent ($3,039.00 / $4,119.00 / $1,093.00 / $2,773.00 / $4,094.00). Sierra View, where it publishes both, prices cash at exactly 70% of gross on all three comparable codes. A self-pay patient reading only Kaweah's file would see no cash discount at all.
Templated values recur within and across files. $1,196.08 appears as Sierra View's median for two different codes and as Kaweah's Medicare-benchmark rate and de-identified minimum for colonoscopy. $4,208.34 appears as Sierra View's knee-arthroscopy median and as Kaweah's Medicare-linked median for the same code. $7,970.59 is Sierra View's rate for four separate payers on DRG 807. Identical cross-payer values are consistent with benchmark-derived publication (e.g., a percentage of a Medicare base) rather than payer-by-payer negotiation; the files do not say which, and this brief does not pretend otherwise.
Duplicate and split publications are common. Kaweah publishes CPT 45378 in two item rows with disjoint payer sets and different de-identified ranges; Sierra View publishes two different case rates for the same payer on DRG 807 (Health Net: $7,970.59 and $12,274.71). This brief merges duplicates by union and uses payer medians where a payer appears twice (Rules, F8).
The two files use different legal encodings of the same federal schema (wide vs tall, §Methodology), different payer naming ("HEALTH NET" vs "HEALTHNET"), and different completeness (Sierra View omits gross charges for 4 of 9 code groups; Kaweah omits them for all DRGs). Nothing about these files is plug-and-play comparable; every comparison above required normalization judgments, which are stated in the Methodology so a reader can reject them.

Methodology — filtering and construction rules (stated in full)

Starting set: 371 payer-rate rows extracted for the nine target codes (the five headline procedures plus 99284, 805, 806, G0121 companions) from the two files.

F1 — Type-aware code matching. A row counts as procedure X only if a code matching X carries the correct code type (CPT/HCPCS for CPT targets; MS-DRG for DRG targets). Code-only matching across all code slots produced 8 false-positive rows from two pharmacy items (emtricitabine-tenofovir products) whose code sets contain an "806" string in a non-primary slot; those rows are excluded and the catch is reported here because any downstream user of these files faces the same trap.
F2 — Setting. CPT procedures: outpatient rows only. DRGs: inpatient rows only. (Removes 40 rows.)
F3 — Dollar form. Headline statistics use only rows with a numeric negotiated-dollar value. Percentage-of-charges rows (34) and algorithm rows (13) are counted and discussed, never converted to dollars. (Sets aside 47 rows.)
F4 — Placeholder screen. Dollar values ≤ $1.00 are excluded as placeholder artifacts. (Removes 4 rows — Sierra View's "KEY NETWORK" $0.01 rates on CPT 72148, 99284, 99285.) No literal 999-style placeholders and no $0 rates were present in the target rows of either file.
F5 — Zero-volume ("ghost") screen: run, reported, NOT applied to headline figures. Both files carry the CMS v3 count field (number of paid amounts behind a rate). Where reported, it is 0 for 65 of 72 non-blank dollar rows — including 19 of Sierra View's 28 MRI rows — a pattern consistent with a vendor default rather than a measured zero-volume signal. Applying the screen mechanically reverses the MRI comparison (Sensitivity Note). Headline figures therefore retain count=0 rows; the screen's effect is disclosed instead of silently baked in.
F6 — Pseudo-payer exclusion. Rows for "NON CONTRACTED" and "SELF-PAY (using Community Rates)" are not negotiated rates and are excluded from negotiated statistics (22 rows). The hospitals' published discounted-cash and de-identified min/max figures are reported separately, as published.
F7 — Methodology consistency. Per-diem dollar rows are excluded from DRG case-rate statistics (1 row: Kaweah Cigna HMO, DRG 807, $4,422.00/day). Fee-schedule-methodology rows are retained unless flagged under F8.
F8 — Duplicates and implausible values. Duplicate item rows for the same hospital/code/setting are merged by union; a payer appearing twice contributes its median. Dollar rows below 20% of the hospital's own all-payer median for that code are flagged as probable component/basis artifacts (14 rows — listed with † in Appendix A), excluded from headline medians, and shown in the appendix. Flagged examples: Sierra View Health Net ED rows at $72.18/$114.13; Sierra View's $551.00 knee-arthroscopy fee-schedule rows.
Payer grouping. "Commercial" = insurer/employer-plan rows not in the Medicare-linked group. "Medicare-linked" = payer names containing Medicare, Medigap, Tricare, or Humana (in these two files, Medicare Advantage or benchmark products). This grouping is a stated judgment; Appendix A lists every row so any reader can re-group. Plan granularity differs by hospital (Kaweah publishes plan-level blocks; Sierra View mostly payer-level), so cross-hospital payer matches are name-normalized and labeled as such.

Resulting headline set: 243 rate rows (257 retained rows minus 14 F8-flagged).

Sensitivity note — the zero-volume screen

If the count = 0 screen (F5) were applied — i.e., if every count=0 rate were treated as a never-paid ghost — commercial medians would move as follows: CPT 72148 Kaweah $985.86 → $1,670.34 and Sierra View $2,697.24-basis comparison collapses to a $306.88 fee-schedule-cluster median — the MRI ranking reverses; CPT 99285 Kaweah $1,632.00 → $2,047.00, Sierra View $1,179.57 → $959.57; DRG 807 Kaweah $7,889.00 → $8,024.50, Sierra View unchanged; all other headline medians move ≤ ~13% or not at all. Because count reporting is blank for 185 of 257 retained rows and zero for ~90% of the rest, this brief treats the field as unreliable in these two files and discloses both treatments. A buyer using this brief for negotiation should know the MRI figures are the fragile ones.

Caveats — what this brief does not establish

Published ≠ paid. These are the hospitals' own published standard charges under the federal price-transparency rule. They are not claims data; this brief does not establish what any payer actually paid for any specific case, and published rates are known to diverge from remittances.
Two of three hospitals. Adventist Health Tulare is absent for access reasons stated above. County-wide statements cover the two publishing hospitals only.
File vintages differ. Sierra View's file is dated April 1, 2026 (data as of January 1, 2026); Kaweah's July 14, 2026. Contracts renegotiated between those dates and November 2026 are not reflected.
Facility component only. Professional (physician) fees are not in these comparisons unless a hospital folded them into a row without saying so; two flagged Sierra View rows appear to be exactly that error in the source file.
Percentage and algorithm contracts are invisible in dollar terms — 14% of rows here, concentrated in delivery care. Any "average price" computed from these files silently omits them.
Benchmark-shaped values. Recurring identical values across payers suggest some published "negotiated" rates are derived from a common benchmark rather than individually negotiated. The files do not identify which rows; treat single-value clusters with suspicion.
Known internal inconsistencies are flagged, not fixed — notably Kaweah CPT 29881 (gross below negotiated rates) and Kaweah CPT 72148's $83.63 minimum. Figures are reproduced as published; the brief does not silently correct source data.
Small denominators. Several medians rest on 4–6 commercial rates (delivery DRGs at Sierra View; knee arthroscopy at Sierra View). They are published-file statistics, not market estimates, and are labeled with their n throughout.
Not legal, compliance, or negotiation advice. This brief describes published data. It does not assess either hospital's compliance with 45 CFR Part 180, and it is not a recommendation to any payer, employer, or union.

End of test brief. Appendix A (payer-level retained rates) follows. Internal workpaper — not for publication or sale.

Appendix A — Payer-level retained dollar rates (canonical set)

Rates below are the rows behind every median in this brief: negotiated-dollar values after filters F1–F4 and F6–F7. Rows marked † were flagged under F8 (implausible/component-basis) and are excluded from medians but shown for completeness. Medicare-linked payers are grouped separately in the headline tables; all retained rows are listed here in file order by hospital.

Colonoscopy, diagnostic — CPT 45378

Hospital	Payer / plan (as printed in file)	Negotiated $	Methodology (as printed)
Kaweah	TRICARE	1,196.08	fee schedule
Kaweah	MEDICARE MANAGED 100%	1,196.08	fee schedule
Kaweah	Blue Cross Medicare Advantage	1,202.12	fee schedule
Kaweah	Employee Health Plan	1,309.24	fee schedule
Kaweah	HUMANA	1,368.75	percent of total billed charges
Kaweah	AETNA	1,841.63	percent of total billed charges
Kaweah	CIGNA HMO	2,129.00	fee schedule
Kaweah	INTERPLAN	2,431.20	other
Kaweah	FIRST HEALTH	2,583.15	percent of total billed charges
Kaweah	HEALTH NET	2,710.79	other
Kaweah	CIGNA PPO	2,735.10	percent of total billed charges
Kaweah	Blue Cross Commercial	2,928.00	fee schedule
Kaweah	MEDIGAP	3,039.00	percent of total billed charges
Kaweah	Western Growers Pinnacle EPO	3,100.00	fee schedule
Kaweah	Blue Shield HMO	3,159.09	fee schedule
Kaweah	UHC Select Core	4,148.00	fee schedule
Kaweah	UHC ALL PAYER	4,948.00	fee schedule
Sierra View	BLUE CROSS	295.23	Fee Schedule
Sierra View	DIGNITY HEALTH	295.23	Fee Schedule
Sierra View	LASALLE	295.23	Fee Schedule
Sierra View	HEALTHNET	1,076.47	Fee Schedule
Sierra View	DIGNITY HEALTH	1,196.08	Fee Schedule
Sierra View	HEALTHNET	1,196.08	Fee Schedule
Sierra View	HUMANA	1,196.08	Fee Schedule
Sierra View	LASALLE	1,196.08	Fee Schedule
Sierra View	DIGNITY HEALTH	1,435.30	Fee Schedule
Sierra View	HEALTHNET	1,841.96	Fee Schedule

Colonoscopy, screening (Medicare) — HCPCS G0121

Hospital	Payer / plan (as printed in file)	Negotiated $	Methodology (as printed)
Sierra View	HEALTHNET	1,076.47	Fee Schedule
Sierra View	DIGNITY HEALTH	1,196.08	Fee Schedule
Sierra View	HEALTHNET	1,196.08	Fee Schedule
Sierra View	HUMANA	1,196.08	Fee Schedule
Sierra View	LASALLE	1,196.08	Fee Schedule
Sierra View	DIGNITY HEALTH	1,435.30	Fee Schedule
Sierra View	HEALTHNET	1,841.96	Fee Schedule

MRI lumbar spine without contrast — CPT 72148

Hospital	Payer / plan (as printed in file)	Negotiated $	Methodology (as printed)
Kaweah	AETNA	83.63	percent of total billed charges
Kaweah	Blue Shield HMO	102.26	other
Kaweah	INTERPLAN	110.40	percent of total billed charges
Kaweah	FIRST HEALTH	117.30	percent of total billed charges
Kaweah	Blue Cross Commercial	121.85	other
Kaweah	HEALTH NET	123.10	other
Kaweah	CIGNA PPO	124.20	percent of total billed charges
Kaweah	MEDIGAP	138.00	percent of total billed charges
Kaweah	TRICARE	306.88	fee schedule
Kaweah	MEDICARE MANAGED 100%	306.88	fee schedule
Kaweah	TRICARE	306.88	fee schedule
Kaweah	MEDICARE MANAGED 100%	306.88	fee schedule
Kaweah	Blue Cross Medicare Advantage	308.43	fee schedule
Kaweah	Blue Cross Medicare Advantage	308.43	fee schedule
Kaweah	Employee Health Plan	335.92	fee schedule
Kaweah	Employee Health Plan	335.92	fee schedule
Kaweah	HUMANA	351.19	percent of total billed charges
Kaweah	HUMANA	351.19	percent of total billed charges
Kaweah	Western Growers Pinnacle EPO	381.73	per diem
Kaweah	Western Growers Pinnacle EPO	381.73	per diem
Kaweah	UHC Select Core	1,590.00	other
Kaweah	Blue Cross Commercial	1,652.87	other
Kaweah	Blue Shield HMO	1,687.80	fee schedule
Kaweah	UHC ALL PAYER	1,830.00	other
Kaweah	AETNA	2,496.11	percent of total billed charges
Kaweah	CIGNA HMO	3,226.69	fee schedule
Kaweah	CIGNA HMO	3,226.69	fee schedule
Kaweah	INTERPLAN	3,295.20	percent of total billed charges
Kaweah	FIRST HEALTH	3,501.15	percent of total billed charges
Kaweah	HEALTH NET	3,674.15	other
Kaweah	CIGNA PPO	3,707.10	percent of total billed charges
Kaweah	MEDIGAP	4,119.00	percent of total billed charges
Sierra View	BLUE CROSS	186.00 †	Fee Schedule
Sierra View	DIGNITY HEALTH	186.00 †	Fee Schedule
Sierra View	LASALLE	186.00 †	Fee Schedule
Sierra View	HEALTHNET	196.42 †	Fee Schedule
Sierra View	DIGNITY HEALTH	306.88 †	Fee Schedule
Sierra View	HEALTHNET	306.88 †	Fee Schedule
Sierra View	HUMANA	306.88 †	Fee Schedule
Sierra View	LASALLE	306.88 †	Fee Schedule
Sierra View	DIGNITY HEALTH	368.26 †	Fee Schedule
Sierra View	HEALTHNET	472.60	Fee Schedule
Sierra View	HEALTHNET	993.72	Percent of Total Billed Charges
Sierra View	HEALTHNET	993.72	Percent of Total Billed Charges
Sierra View	BCBS	1,000.00	Percent of Total Billed Charges
Sierra View	BCBS	1,000.00	Percent of Total Billed Charges
Sierra View	AETNA	2,174.00	Percent of Total Billed Charges
Sierra View	AETNA	2,174.00	Percent of Total Billed Charges
Sierra View	KAISER	2,484.30	Percent of Total Billed Charges
Sierra View	KAISER	2,484.30	Percent of Total Billed Charges
Sierra View	HEALTHNET	2,661.75	Percent of Total Billed Charges
Sierra View	MULTIPLAN	2,732.73	Percent of Total Billed Charges
Sierra View	MULTIPLAN	2,732.73	Percent of Total Billed Charges
Sierra View	HEALTHSMART	3,016.65	Percent of Total Billed Charges
Sierra View	MULTIPLAN	3,016.65	Percent of Total Billed Charges
Sierra View	HEALTHSMART	3,016.65	Percent of Total Billed Charges
Sierra View	MULTIPLAN	3,016.65	Percent of Total Billed Charges
Sierra View	BLUE SHIELD	3,165.71	Percent of Total Billed Charges
Sierra View	BLUE SHIELD	3,165.71	Percent of Total Billed Charges
Sierra View	CIGNA	3,194.10	Percent of Total Billed Charges
Sierra View	CIGNA	3,194.10	Percent of Total Billed Charges

Knee arthroscopy with meniscectomy — CPT 29881

Hospital	Payer / plan (as printed in file)	Negotiated $	Methodology (as printed)
Kaweah	AETNA	662.36	percent of total billed charges
Kaweah	Blue Shield HMO	809.91	other
Kaweah	CIGNA HMO	819.75	other
Kaweah	INTERPLAN	874.40	percent of total billed charges
Kaweah	Blue Cross Commercial	892.43	other
Kaweah	FIRST HEALTH	929.05	percent of total billed charges
Kaweah	HEALTH NET	974.96	other
Kaweah	CIGNA PPO	983.70	percent of total billed charges
Kaweah	MEDIGAP	1,093.00	percent of total billed charges
Kaweah	TRICARE	4,208.34	fee schedule
Kaweah	MEDICARE MANAGED 100%	4,208.34	fee schedule
Kaweah	Blue Cross Medicare Advantage	4,229.60	fee schedule
Kaweah	Employee Health Plan	4,606.49	fee schedule
Kaweah	HUMANA	4,815.88	percent of total billed charges
Kaweah	Western Growers Pinnacle EPO	5,234.65	per diem
Sierra View	BLUE CROSS	551.00 †	Fee Schedule
Sierra View	DIGNITY HEALTH	551.00 †	Fee Schedule
Sierra View	LASALLE	551.00 †	Fee Schedule
Sierra View	HEALTHNET	3,787.51	Fee Schedule
Sierra View	DIGNITY HEALTH	4,208.34	Fee Schedule
Sierra View	HEALTHNET	4,208.34	Fee Schedule
Sierra View	HUMANA	4,208.34	Fee Schedule
Sierra View	LASALLE	4,208.34	Fee Schedule
Sierra View	DIGNITY HEALTH	5,050.01	Fee Schedule
Sierra View	HEALTHNET	6,480.84	Fee Schedule

Emergency department visit, level 5 — CPT 99285

Hospital	Payer / plan (as printed in file)	Negotiated $	Methodology (as printed)
Kaweah	Blue Shield HMO	266.76	other
Kaweah	CIGNA HMO	270.00	other
Kaweah	INTERPLAN	288.00	percent of total billed charges
Kaweah	Blue Cross Commercial	293.94	other
Kaweah	FIRST HEALTH	306.00	percent of total billed charges
Kaweah	HEALTH NET	321.12	other
Kaweah	CIGNA PPO	324.00	percent of total billed charges
Kaweah	MEDIGAP	360.00	percent of total billed charges
Kaweah	TRICARE	765.95	fee schedule
Kaweah	MEDICARE MANAGED 100%	765.95	fee schedule
Kaweah	TRICARE	765.95	fee schedule
Kaweah	MEDICARE MANAGED 100%	765.95	fee schedule
Kaweah	Blue Cross Medicare Advantage	769.82	fee schedule
Kaweah	Blue Cross Medicare Advantage	769.82	fee schedule
Kaweah	Employee Health Plan	838.42	fee schedule
Kaweah	Employee Health Plan	838.42	fee schedule
Kaweah	HUMANA	876.53	percent of total billed charges
Kaweah	HUMANA	876.53	percent of total billed charges
Kaweah	Western Growers Pinnacle EPO	952.75	per diem
Kaweah	Blue Shield HMO	1,518.00	case rate
Kaweah	UHC Select Core	1,746.00	fee schedule
Kaweah	Western Growers Pinnacle EPO	2,047.00	percent of total billed charges
Kaweah	UHC ALL PAYER	2,089.00	fee schedule
Kaweah	CIGNA HMO	3,070.50	other
Kaweah	INTERPLAN	3,275.20	percent of total billed charges
Kaweah	AETNA	3,328.00	case rate
Kaweah	AETNA	3,328.00	case rate
Kaweah	Blue Cross Commercial	3,337.43	other
Kaweah	FIRST HEALTH	3,479.90	percent of total billed charges
Kaweah	HEALTH NET	3,651.85	other
Kaweah	CIGNA PPO	3,684.60	percent of total billed charges
Kaweah	MEDIGAP	4,094.00	percent of total billed charges
Sierra View	HEALTHNET	114.13 †	Fee Schedule
Sierra View	DIGNITY HEALTH	765.95	Fee Schedule
Sierra View	HEALTHNET	765.95	Fee Schedule
Sierra View	HUMANA	765.95	Fee Schedule
Sierra View	LASALLE	765.95	Fee Schedule
Sierra View	DIGNITY HEALTH	919.14	Fee Schedule
Sierra View	BCBS	1,000.00	Percent of Total Billed Charges
Sierra View	AETNA	1,149.00	Percent of Total Billed Charges
Sierra View	HEALTHNET	1,179.57	Fee Schedule
Sierra View	KAISER	1,608.60	Percent of Total Billed Charges
Sierra View	MULTIPLAN	1,769.46	Percent of Total Billed Charges
Sierra View	HEALTHSMART	1,953.30	Percent of Total Billed Charges
Sierra View	MULTIPLAN	1,953.30	Percent of Total Billed Charges
Sierra View	BLUE SHIELD	2,049.82	Percent of Total Billed Charges
Sierra View	CIGNA	2,068.20	Percent of Total Billed Charges

Emergency department visit, level 4 — CPT 99284

Hospital	Payer / plan (as printed in file)	Negotiated $	Methodology (as printed)
Kaweah	Blue Shield HMO	184.51	other
Kaweah	CIGNA HMO	186.75	other
Kaweah	INTERPLAN	199.20	percent of total billed charges
Kaweah	Blue Cross Commercial	203.31	other
Kaweah	FIRST HEALTH	211.65	percent of total billed charges
Kaweah	HEALTH NET	222.11	other
Kaweah	CIGNA PPO	224.10	percent of total billed charges
Kaweah	MEDIGAP	249.00	percent of total billed charges
Kaweah	TRICARE	536.67	fee schedule
Kaweah	MEDICARE MANAGED 100%	536.67	fee schedule
Kaweah	TRICARE	536.67	fee schedule
Kaweah	MEDICARE MANAGED 100%	536.67	fee schedule
Kaweah	Blue Cross Medicare Advantage	539.38	fee schedule
Kaweah	Blue Cross Medicare Advantage	539.38	fee schedule
Kaweah	Employee Health Plan	587.44	fee schedule
Kaweah	Employee Health Plan	587.44	fee schedule
Kaweah	HUMANA	614.15	percent of total billed charges
Kaweah	HUMANA	614.15	percent of total billed charges
Kaweah	Western Growers Pinnacle EPO	667.55	per diem
Kaweah	Western Growers Pinnacle EPO	1,386.50	percent of total billed charges
Kaweah	Blue Shield HMO	1,518.00	case rate
Kaweah	UHC Select Core	1,746.00	fee schedule
Kaweah	CIGNA HMO	2,079.75	other
Kaweah	AETNA	2,089.00	case rate
Kaweah	UHC ALL PAYER	2,089.00	fee schedule
Kaweah	AETNA	2,089.00	case rate
Kaweah	INTERPLAN	2,218.40	percent of total billed charges
Kaweah	Blue Cross Commercial	2,260.55	other
Kaweah	FIRST HEALTH	2,357.05	percent of total billed charges
Kaweah	HEALTH NET	2,473.52	other
Kaweah	CIGNA PPO	2,495.70	percent of total billed charges
Kaweah	MEDIGAP	2,773.00	percent of total billed charges
Sierra View	HEALTHNET	72.18 †	Fee Schedule
Sierra View	DIGNITY HEALTH	536.67	Fee Schedule
Sierra View	HEALTHNET	536.67	Fee Schedule
Sierra View	HUMANA	536.67	Fee Schedule
Sierra View	LASALLE	536.67	Fee Schedule
Sierra View	AETNA	613.00	Percent of Total Billed Charges
Sierra View	DIGNITY HEALTH	644.00	Fee Schedule
Sierra View	HEALTHNET	826.47	Fee Schedule
Sierra View	KAISER	858.20	Percent of Total Billed Charges
Sierra View	MULTIPLAN	944.02	Percent of Total Billed Charges
Sierra View	BCBS	1,000.00	Percent of Total Billed Charges
Sierra View	HEALTHSMART	1,042.10	Percent of Total Billed Charges
Sierra View	MULTIPLAN	1,042.10	Percent of Total Billed Charges
Sierra View	BLUE SHIELD	1,093.59	Percent of Total Billed Charges
Sierra View	CIGNA	1,103.40	Percent of Total Billed Charges

Vaginal delivery without CC/MCC — MS-DRG 807

Hospital	Payer / plan (as printed in file)	Negotiated $	Methodology (as printed)
Kaweah	FIRST HEALTH	1,650.00	other
Kaweah	TRICARE	5,208.06	other
Kaweah	Blue Cross Medicare Advantage	5,972.00	case rate
Kaweah	Western Growers Pinnacle EPO	7,056.00	other
Kaweah	MEDICARE MANAGED 100%	7,322.96	other
Kaweah	HEALTH NET	7,649.00	other
Kaweah	UHC Select Core	8,129.00	other
Kaweah	Blue Shield HMO	8,400.00	other
Kaweah	UHC ALL PAYER	9,106.00	other
Sierra View	DIGNITY HEALTH	7,970.59	Case Rate
Sierra View	HEALTHNET	7,970.59	Case Rate
Sierra View	HUMANA	7,970.59	Case Rate
Sierra View	LASALLE	7,970.59	Case Rate
Sierra View	HEALTHNET	12,274.71	Case Rate

Vaginal delivery with CC — MS-DRG 806

Hospital	Payer / plan (as printed in file)	Negotiated $	Methodology (as printed)
Kaweah	FIRST HEALTH	1,650.00	other
Kaweah	TRICARE	5,052.18	other
Kaweah	INTERPLAN	5,500.00	case rate
Kaweah	Blue Cross Medicare Advantage	6,678.86	case rate
Kaweah	Western Growers Pinnacle EPO	7,056.00	other
Kaweah	HEALTH NET	7,649.00	other
Kaweah	UHC Select Core	8,129.00	other
Kaweah	MEDICARE MANAGED 100%	8,150.00	other
Kaweah	Blue Shield HMO	8,400.00	other
Kaweah	UHC ALL PAYER	9,106.00	other
Sierra View	DIGNITY HEALTH	8,865.37	Case Rate
Sierra View	HEALTHNET	8,865.37	Case Rate
Sierra View	HUMANA	8,865.37	Case Rate
Sierra View	LASALLE	8,865.37	Case Rate
Sierra View	HEALTHNET	13,652.67	Case Rate

Vaginal delivery with MCC — MS-DRG 805

Hospital	Payer / plan (as printed in file)	Negotiated $	Methodology (as printed)
Kaweah	FIRST HEALTH	1,650.00	other
Kaweah	TRICARE	4,653.19	other
Kaweah	Western Growers Pinnacle EPO	7,056.00	other
Kaweah	HEALTH NET	7,649.00	other
Kaweah	UHC Select Core	8,129.00	other
Kaweah	Blue Shield HMO	8,400.00	other
Kaweah	UHC ALL PAYER	9,106.00	other
Kaweah	Blue Cross Medicare Advantage	9,559.45	case rate
Kaweah	MEDICARE MANAGED 100%	11,520.30	other
Sierra View	DIGNITY HEALTH	12,511.74	Case Rate
Sierra View	HEALTHNET	12,511.74	Case Rate
Sierra View	HUMANA	12,511.74	Case Rate
Sierra View	LASALLE	12,511.74	Case Rate
Sierra View	HEALTHNET	19,268.08	Case Rate

This sample is research and analysis from public documents. Published rates are not paid claims. Not legal, compliance, or negotiation advice. The Negotiated Rate Brief is a ForTre Partners Health Care Infrastructure product — the practice line and how to commission one.