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.
31 prices shown (filtered).
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| 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 | — | — | |
| acetaZOLAMIDE 250 mg Tablet 100 Each Bottle Inpatient & outpatient | 999999 HCPCS | $1.63 | $1.63 | — | — | |
| albuterol 1.25 mg/3 mL Neb. soln 3 mL Vial Inpatient & outpatient | 999999 HCPCS | $2.66 | $2.66 | — | — | |
| Albuterol sulfate in ns for cont inhalation (rt) 1 each vial Inpatient & outpatient | 999999 HCPCS | $2.23 | $2.23 | — | — | |
| aspirin chewable tablet 81 mg chew tab 90 Each Bottle Inpatient & outpatient | 999999 HCPCS | $1.15 | $1.15 | — | — | |
| Cephalexin 500 mg capsule 100 each blist pack Inpatient & outpatient | 999999 HCPCS | $1.15 | $1.15 | — | — | |
| cetirizine 10 mg Tablet 100 Each Bottle Inpatient & outpatient | 999999 HCPCS | $1.15 | $1.15 | — | — | |
| Clonidine hcl 0.1 mg tablet 100 each blist pack Inpatient & outpatient | 999999 HCPCS | $1.15 | $1.15 | — | — | |
| dextrose 50 % in water (D50W) Parenter sol 50 mL Vial Inpatient & outpatient | 999999 HCPCS | $17.94 | $17.94 | — | — | |
| fentaNYL 100 mcg/hr Patch 72hr 5 Each Box Inpatient & outpatient | 999999 HCPCS | $128 | $128 | — | — | |
| fentaNYL 12 mcg/hr Patch 72hr 5 Each Box Inpatient & outpatient | 999999 HCPCS | $59.59 | $59.59 | — | — | |
| fentaNYL 25 mcg/hr Patch 72hr 5 Each Box Inpatient & outpatient | 999999 HCPCS | $8.70 | $8.70 | — | — | |
| fentaNYL 50 mcg/hr Patch 72hr 1 Each Packet Inpatient & outpatient | 999999 HCPCS | $57.81 | $57.81 | — | — | |
| Gabapentin 100 mg capsule 100 each blist pack Inpatient & outpatient | 999999 HCPCS | $1.15 | $1.15 | — | — | |
| ibuprofen 100 mg/5 mL Suspension 5 mL Cup Inpatient & outpatient | 999999 HCPCS | $4.74 | $4.74 | — | — | |
| Ibuprofen 200 mg tablet 100 each blist pack Inpatient & outpatient | 999999 HCPCS | $1.15 | $1.15 | — | — | |
| Ibuprofen 800 mg tablet 100 each blist pack Inpatient & outpatient | 999999 HCPCS | $1.15 | $1.15 | — | — | |
| ipratropium 0.02 % Solution 2.5 mL Vial Inpatient & outpatient | 999999 HCPCS | $1.15 | $1.15 | — | — | |
| ipratropium-albuteroL 0.5 mg-3 mg(2.5 mg base)/3 mL Neb. soln 3 mL Vial Inpatient & outpatient | 999999 HCPCS | $1.36 | $1.36 | — | — | |
| Labetalol 100 mg tablet 100 each blist pack Inpatient & outpatient | 999999 HCPCS | $1.46 | $1.46 | — | — | |
| levalbuterol 0.63 mg/3 mL Neb. soln 3 mL Vial Inpatient & outpatient | 999999 HCPCS | $12.93 | $12.93 | — | — | |
| levalbuterol 1.25 mg/0.5 mL Neb. soln 1 Each Vial Inpatient & outpatient | 999999 HCPCS | $24.82 | $24.82 | — | — | |
| lidocaine 4 % (40 mg/mL) Solution 50 mL Bottle Inpatient & outpatient | 999999 HCPCS | $183 | $183 | — | — | |
| lidocaine jelly 2 % Jelp 11 mL Syringe Inpatient & outpatient | 999999 HCPCS | $22.72 | $22.72 | — | — | |
| lidocaine jelly 2 % Jelp 6 mL Syringe Inpatient & outpatient | 999999 HCPCS | $17.66 | $17.66 | — | — | |
| lidocaine-EPINEPHrine 0.5 %-1:200,000 Solution 50 mL Vial Inpatient & outpatient | 999999 HCPCS | $7.00 | $7.00 | — | — | |
| Lidocaine-prilocaine (emla) 2.5-2.5 % cream 2.5-2.5 % cream 5 g tube Inpatient & outpatient | 999999 HCPCS | $35.93 | $35.93 | — | — | |
| NaCl 0.9% bacteriostatic injection 0.9 % Solution 30 mL Vial Inpatient & outpatient | 999999 HCPCS | $7.00 | $7.00 | — | — | |
| naltrexone 50 mg Tablet 30 Each Bottle Inpatient & outpatient | 999999 HCPCS | $4.53 | $4.53 | — | — |