Upper Valley Medical Center — price list
← Hospital overviewVerified from Upper Valley Medical Center’s published price file
Includes cash prices, list prices. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.
Showing the first 1,500 prices from a large file. Search a procedure or code below to narrow the list.
How to read these columns
- List
- The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
- Cash
- The discounted self-pay price for paying directly, without insurance.
- Negotiated
- Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.
These are the hospital’s published reference prices, not a personalized estimate of your bill.
1,500 prices shown.
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| 0.9% NaCl Solution 1,000 mL Flex Cont Inpatient & outpatient | J7030 HCPCS | $29.75 | $29.75 | — | — | |
| 0.9% NaCl Solution 100 mL Bag Inpatient & outpatient | J3490 HCPCS | $0.01 | $0.01 | — | — | |
| 0.9% NaCl Solution 25 mL Bag Inpatient & outpatient | J3490 HCPCS | $0.01 | $0.01 | — | — | |
| 0.9% NaCl Solution 250 mL Flex Cont Inpatient & outpatient | J7050 HCPCS | $0.01 | $0.01 | — | — | |
| 0.9% NaCl Solution 500 mL Flex Cont Inpatient & outpatient | J7040 HCPCS | $35.70 | $35.70 | — | — | |
| 3% hypertonic sodium chloride 3 % parenter sol 250 ml bag Inpatient & outpatient | J7131 HCPCS | $29.75 | $29.75 | — | — | |
| 3% hypertonic sodium chloride 3 % parenter sol 500 ml bag Inpatient & outpatient | J7131 HCPCS | $29.75 | $29.75 | — | — | |
| 3% hypertonic sodium chloride 3% parenter sol 500 ml flex cont Inpatient & outpatient | 00000RX00338005403 CDM | $29.75 | $29.75 | — | — | |
| abacavir 20 mg/mL Solution 15 mL Cup Inpatient & outpatient | 00000RX00073074015 CDM | $8.03 | $8.03 | — | — | |
| abacavir 300 mg Tablet 60 Each Bottle Inpatient & outpatient | 00000RX31722055760 CDM | $4.55 | $4.55 | — | — | |
| abatacept 250 mg Recon soln 1 Each Vial Inpatient & outpatient | J0129 HCPCS | $3,671 | $3,671 | — | — | |
| Abemaciclib 100 mg tablet 14 each blist pack Inpatient & outpatient | 00000RX00002481554 CDM | $764 | $764 | — | — | |
| Abemaciclib 150 mg tablet 14 each blist pack Inpatient & outpatient | 00000RX00002533754 CDM | $764 | $764 | — | — | |
| Abemaciclib 200 mg tablet 14 each blist pack Inpatient & outpatient | 00000RX00002621654 CDM | $764 | $764 | — | — | |
| Abemaciclib 50 mg tablet 14 each blist pack Inpatient & outpatient | 00000RX00002448354 CDM | $764 | $764 | — | — | |
| abiraterone 250 mg Tablet 120 Each Bottle Inpatient & outpatient | 00000RX57894015012 CDM | $462 | $462 | — | — | |
| acamprosate 333 mg Tab ec 180 Each Bottle Inpatient & outpatient | 00000RX00378633380 CDM | $3.80 | $3.80 | — | — | |
| Acamprosate 333 mg tab ec 50 each blist pack Inpatient & outpatient | 00000RX51079024106 CDM | $3.16 | $3.16 | — | — | |
| Acebutolol 200 mg capsule 50 each blist pack Inpatient & outpatient | 00000RX50268005015 CDM | $5.21 | $5.21 | — | — | |
| acetaminophen 1,000 mg/100 mL (10 mg/mL) Solution 100 mL Flex Cont Inpatient & outpatient | J0137 HCPCS | $22.88 | $22.88 | — | — | |
| acetaminophen 1,000 mg/100 mL (10 mg/mL) Solution 100 mL Flex Cont Inpatient & outpatient | J0131 HCPCS | $43.68 | $43.68 | — | — | |
| acetaminophen 120 mg Suppository 1 Each Box Inpatient & outpatient | 00000RX45802073200 CDM | $1.42 | $1.42 | — | — | |
| acetaminophen 120 mg Suppository 12 Each Box Inpatient & outpatient | 00000RX45802073230 CDM | $1.42 | $1.42 | — | — | |
| acetaminophen 160 mg/5 mL (5 mL) Suspension 5 mL Cup Inpatient & outpatient | 00000RX00121178100 CDM | $3.37 | $3.37 | — | — | |
| acetaminophen 160 mg/5 mL (5 mL) Suspension 5 mL Cup Inpatient & outpatient | 00000RX00121178105 CDM | $3.37 | $3.37 | — | — | |
| acetaminophen 325 mg Suppository 1 Each Box Inpatient & outpatient | 00000RX51672211600 CDM | $3.10 | $3.10 | — | — | |
| acetaminophen 325 mg Suppository 6 Each Box Inpatient & outpatient | 00000RX51672211602 CDM | $3.10 | $3.10 | — | — | |
| Acetaminophen 325 mg tablet 100 each blist pack Inpatient & outpatient | 999999 HCPCS | $1.15 | $1.15 | — | — | |
| Acetaminophen 500 mg tablet 100 each blist pack Inpatient & outpatient | 999999 HCPCS | $1.15 | $1.15 | — | — | |
| acetaminophen 650 mg Suppository 100 Each Box Inpatient & outpatient | 00000RX45802073033 CDM | $1.15 | $1.15 | — | — |