Supplies, drugs & other prices at Upper Valley Medical Center

Troy, OH · every code in this section with a posted price and a Medicare benchmark.

45 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
Adm tocilizu covid-19 1st (M0249) $843 $843 2.0×
Catheterize for urine spec (P9612) $30 $30 3.2×
Diab manage trn per indiv (G0108) $85 $85 1.5×
Diab manage trn ind/group (G0109) $23 $23 1.4×
Ed svc ckd grp per session (G0421) $56 $56 2.0×
Ed svc ckd ind per session (G0420) $223 $223 2.0×
Ev fempop artl revsc tcat plmt IV st grf & clsr (0505T) $20,172 $20,172 1.8×
Group mnt 2 or more 30 mins (G0271) $36 $36 2.1×
Hbot, full body chamber, 30m (G0277) $972 $972 7.2×
Histotripsy mal hepatocellular tiss w/img gdn (0686T) $33,701 $33,701 2.0×
Insj/Rplc Car Modulj Sys Pls Gen Transvns Eltrd (0408T) $56,463 $56,463 1.8×
Insj/Rplc Car Modulj Sys Ventr Electrode Only (0411T) $28,589 $28,589 3.5×
Insj/Rplc Cardiac Modulj Sys Atr Electrode Only (0410T) $28,589 $28,589 3.5×
Insj/Rplc Cardiac Modulj Sys Pls Generator Only (0409T) $45,742 $45,742 2.1×
Instlj fecal microbiota ssp (0780T) $249 $249 1.9×
Ire Abltj 1+Tum Organ Perq (0600T) $14,903 $14,903 1.4×
Liver Dis 10 Assays Serum Algorithm W/Nash (0003M) $3,920 $3,920 7.8×
Mnt subs tx for change dx (G0270) $54 $54 1.7×
Mri w/cont, breast, bi (C8906) $6,800 $6,800 19.9×
Mri w/cont, breast, uni (C8903) $3,400 $3,400 19.8×
Neuro csf prion prtn qual (0035U) $3,432 $3,432 6.3×
Nfct ds bact&fng org id bld cul rrna fish 6+trgt (0086U) $1,743 $1,743 8.7×
Onc aml DNA gntyp int tandem dup detcj/nondetcj (0023U) $2,167 $2,167 8.7×
Perq Sacral Augmt Bilat Inj (0201T) $13,178 $13,178 1.9×
Perq Sacral Augmt Unilat Inj (0200T) $13,178 $13,178 1.9×
Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) $43,578 $43,578 3.9×
Place device/marker, non pro (C9728) $4,136 $4,136 3.0×
Prgrmg dev eval scrms phys/qhp remote (0650T) $254 $254 6.9×
Quan MRI alys brain w/o diagnostic MRI same sess (0865T) $1,456 $1,456 6.2×
Quan MRI alys brain with diagnostic MRI (0866T) $3,016 $3,016 12.9×
Reloc Skin Pocket Cardiac Modulj Pulse Generator (0416T) $12,865 $12,865 6.4×
Repos Cardiac Modulj Transvenous Electrode (0415T) $10,006 $10,006 16.3×
Rmvl & Rpl Cardiac Modulj Sys Pls Generator Only (0414T) $45,742 $45,742 2.1×
Rmvl Car Modulj Tranvns Elt (0413T) $17,153 $17,153 4.7×
Rmvl Cardiac Modulj Pls Gen (0412T) $17,153 $17,153 4.7×
Sim ang w/prs cath rad emb (C8004) $12,500 $12,500 1.1×
Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) $7,793 $7,793 1.4×
Tpmt and Nudt15 Genotype (0034U) $3,630 $3,630 7.8×
Trgt gen seq alys sld orgn neo DNA 324 genes (0037U) $11,357 $11,357 3.2×
Trluml perip athrc abd aorta (0236T) $34,259 $34,259 3.0×
Trluml Perip Athrc Brchiocph (0237T) $34,259 $34,259 3.0×
Trluml Perip Athrc Iliac Art (0238T) $34,259 $34,259 1.9×
Trluml Peripheral Atherectomy Renal Artery Ea (0234T) $32,761 $32,761 2.9×
Unsched dialysis esrd pt hos (G0257)
range across 2 matching MRF lines		 $4,310–$5,419 $4,310–$5,419 varies
Vasc emb/occ w/prs cath (C9797)
range across 2 matching MRF lines		 $25,900–$25,958 $25,900–$25,958 varies

A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.