Valley Children's Hospital
9300 Valley Childrens Place, Madera, CA 93636 · 121 Priced Procedures
Typical commercial prices here are +67% above the fair benchmark (1.67×) even after accounting for local nurse/doctor wages and patient complexity.
Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.
Loss-Leader / Captive Ancillary Cross-Subsidizer
Valley Children's Hospital prices routine shoppable procedures near 1.4× Medicare (p50 1.18×) while skewing captive emergency, lab, and upper-quartile codes to 2.0× Medicare (p75 2.02×, +71% upper-tail jump). Patients scheduling elective outpatient care can capture competitive rates, but emergency and ancillary bills require strict line-item auditing.
Where They're Good (Patient & Payer Edge)
- Bottom-quartile procedures (Q25) price at 0.61× the peer BaseRate benchmark
- Self-pay cash beats commercial insurance on 0% of shoppable procedures (50/100 Cash Honesty)
- CMS clinical safety score (54/100 safety score) with 72% patient recommendation
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (55.0% AGB cap)
Where You Can Get Burned (Markup Traps)
- Outpatient surgery & OR suites carry a 1.8× markup over Medicare rates
- Captive ER (1.1×) & laboratory (2.7×) services average 1.43× higher multiples than routine shoppable care (1.4×)
- Upper-quartile procedures (Q75 2.02×) jump +71% above the median procedure ratio (Q50 1.18×)
- Consolidated metro market (HHI 3,609) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
Pre-scheduled outpatient procedures where patients can comparison-shop.
Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.
Detects median-gaming when upper-quartile codes spike above the p50 median.
Procedure Prices at Valley Children's Hospital
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 121 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Total hip replacement CPT Code: 27130 | $2,991 | 0.2× |
| Total knee replacement CPT Code: 27447 | $2,991 | 0.2× |
| Vaginal delivery (full package) CPT Code: 59400 | $2,186 | 0.8× |
| C-section delivery (full package) CPT Code: 59510 | $2,186 | 0.7× |
| Cataract surgery with lens implant CPT Code: 66984 | $2,047 | 0.8× |
| MRI, brain (with and without contrast) CPT Code: 70553 | $2,051 | unverified |
| MRI, lower back (no contrast) CPT Code: 72148 | $1,280 | unverified |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $1,237 | 0.4× |
| MRI, brain (no contrast) CPT Code: 70551 | $1,133 | unverified |
| Upper endoscopy with biopsy CPT Code: 43239 | $1,050 | 1.1× |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $1,056 | 0.2× |
| MRI, knee or other leg joint CPT Code: 73721 | $885 | unverified |
| Colonoscopy with biopsy CPT Code: 45380 | $856 | 0.7× |
| Bunion correction surgery CPT Code: 28296 | $876 | 0.3× |
| Sleep study (overnight, in lab) CPT Code: 95810 | $749 | 0.7× |
| Inguinal hernia repair CPT Code: 49505 | $765 | 0.2× |
| Colonoscopy (diagnostic) CPT Code: 45378 | $656 | 0.7× |
| CT scan, head (with contrast) CPT Code: 70460 | $512 | 2.1× |
| CT scan, head (with and without contrast) CPT Code: 70470 | $512 | 2.0× |
| CT scan, chest (no contrast) CPT Code: 71250 | $517 | unverified |
| CT scan, neck (cervical spine) CPT Code: 72125 | $517 | unverified |
| CT scan, lower back (lumbar spine) CPT Code: 72131 | $517 | unverified |
| CT scan, pelvis CPT Code: 72192 | $517 | unverified |
| Rabies immune globulin HCPCS Code: 90375 | $445 | 1.4× |
| Breast lump removal CPT Code: 19120 | $469 | 0.1× |
Audit a Bill or Quote at Valley Children's Hospital (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $3,948
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (55.0% of gross = $3,948).
Compare Prompt-Pay Cash Rate Against Remaining Deductible
Ask Valley Children's Hospital's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.
Negotiate Toward $13,413 Fair BaseRate ($13,117 Medicare)
Your entered amount is at or below the modeled Fair BaseRate benchmark ($13,413).
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (55.0% of gross charges)
Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.
Clinical Quality, Patient Experience & Infection Benchmarks
CMS Price Transparency Administrative Enforcement Log
Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Valley Children's Hospital. Prior administrative notices do not necessarily reflect current compliance status.
- 2025-11-07·administrative_or_closure
Closure Notice
Recorded - 2025-08-06·warning_notice
Warning Notice
Recorded
Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Valley Children's Hospital.
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.