Tri Valley Health System
1305 West Highway 6/34, Cambridge, NE 69022 · 107 Priced Procedures
Typical commercial prices here are +63% above the fair benchmark (1.63×) even after accounting for local nurse/doctor wages and patient complexity.
Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.
Wide Procedure Spread · Upper-Quartile Skew Pricer
Tri Valley Health System prices routine shoppable procedures at 2.8× Medicare (median 1.45× Fair BaseRate) while upper-quartile commercial rates jump +81% to 2.63× Fair BaseRate. Self-pay cash discounts and comparing specific CPT procedure codes before scheduling yield the strongest savings.
Where They're Good (Patient & Payer Edge)
- Bottom-quartile procedures (Q25) price at 0.27× the peer BaseRate benchmark
- Self-pay cash beats commercial insurance on 29% of shoppable procedures (44/100 Cash Honesty)
- CMS clinical safety score (68/100 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 (50.1% AGB cap)
Where You Can Get Burned (Markup Traps)
- Outpatient surgery & OR suites carry a 1.1× markup over Medicare rates
- Commercial insurance median sits at 1.45× Fair BaseRate (2.8× Medicare), so insured patients should always compare the self-pay cash price before paying.
- Upper-quartile procedures (Q75 2.63×) jump +81% above the median procedure ratio (Q50 1.45×)
- Unnegotiated chargemaster list prices average 11.4× Medicare (20¢ true HCRIS cost per $1 gross)
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 Tri Valley Health System
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 107 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Digestive disorders treatment (inpatient stay) MS-DRG Code: 392 | $23,707 | 2.9× |
| C-section delivery (full package) CPT Code: 59510 | $5,548 | unverified |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $5,056 | 11.3× |
| Vaginal delivery (full package) CPT Code: 59400 | $5,040 | unverified |
| Sleep study (overnight, in lab) CPT Code: 95810 | $4,769 | 4.7× |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $4,251 | 14.0× |
| MRI, brain (with and without contrast) CPT Code: 70553 | $4,172 | 8.2× |
| Cataract surgery with lens implant CPT Code: 66984 | $3,896 | 1.5× |
| MRI, brain (no contrast) CPT Code: 70551 | $3,708 | 10.8× |
| CT scan, head (with contrast) CPT Code: 70460 | $3,681 | 15.2× |
| CT scan, lower back (lumbar spine) CPT Code: 72131 | $3,191 | 19.0× |
| CT scan, neck (cervical spine) CPT Code: 72125 | $3,191 | 18.9× |
| CT scan, pelvis CPT Code: 72192 | $2,812 | 17.3× |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $2,624 | 4.5× |
| CT scan, chest (no contrast) CPT Code: 71250 | $2,582 | 15.5× |
| CT scan, sinuses CPT Code: 70486 | $2,243 | 13.5× |
| Total knee replacement CPT Code: 27447 | $2,117 | 0.2× |
| Total hip replacement CPT Code: 27130 | $2,080 | 0.2× |
| Trauma team activation HCPCS Code: G0390 | $2,039 | 1.4× |
| MRI, lower back (no contrast) CPT Code: 72148 | $1,954 | 5.8× |
| Ultrasound, leg veins (duplex) CPT Code: 93970 | $1,798 | 6.6× |
| CT scan, head (with and without contrast) CPT Code: 70470 | $1,737 | 6.7× |
| MRI, knee or other leg joint CPT Code: 73721 | $1,485 | 4.0× |
| CT scan, head (no contrast) CPT Code: 70450 | $1,371 | 8.6× |
| Blood transfusion CPT Code: 36430 | $1,328 | 2.7× |
Audit a Bill or Quote at Tri Valley Health System (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $13,186
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (50.1% of gross = $13,186).
Self-Pay Cash Rate ($23,707) Beats Your Bill
Tri Valley Health System's published 45 CFR § 180 self-pay cash rate is $23,707 (vs. $23,707 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Negotiate Toward $8,223 Fair BaseRate ($5,676 Medicare)
Your bill ($26,341) is $18,118 above the denoised Fair BaseRate ($8,223) and 4.6× the $5,676 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (50.1% 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 Tri Valley Health System. Prior administrative notices do not necessarily reflect current compliance status.
- 2024-04-02·administrative_or_closure
Met Requirements
Recorded - 2023-03-24·administrative_or_closure
Met Requirements
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 Tri Valley Health System.
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.