CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Tri Valley Health System

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $21,535
Cash Discount Price: $23,707
vs. Medicare Baseline: 3.79x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Tri Valley Health System is $21,535. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $23,707. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 3.79x the Medicare baseline. Located in 1305 West Highway 6/34, Cambridge, NE.

Cash / Self-Pay

$23,707

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,535

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$5,675.87

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $5,675.87 (100%)

Cash / Self-Pay: $23,707 (418%)

Insurance Median: $21,535 (379%)

Cash: $23,707 (418% of Medicare)

Ins. Median: $21,535 (379% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $5,675.87 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 379% of the Medicare baseline (a markup of 279%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$12,924 - $25,024	228%
Humana	$12,924	228%
Medica Mcr Adv	$12,924	228%
Medica Prime Sol	$12,924	228%
Tricare	$12,924	228%
Wellcare Mcr Adv - All Plans	$12,924	228%
Great Plains Mcr Adv - All Plans	$13,570	239%
Healthy Blue Mcaid - All Plans	$18,984	334%
Molina Mcaid - All Plans	$18,984	334%
Nebraska Total Care-All Plans	$18,984	334%
UnitedHealthcare	$18,984 - $25,287	334%
Amerigroup Mcaid - All Plans	$19,364	341%
Medica Chi Aco - All Other Plans	$23,706	418%
Medica Chi Open Access	$23,706	418%
Medica Ifb Aco	$23,706	418%
Medica Ifb Open Access	$23,706	418%
Midlands Choice-All Plans	$23,706	418%
Aetna	$25,814	455%
Multiplan-All Plans	$25,814	455%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $23,707.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 392.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Tri Valley Health System is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 392.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.