How many shoppable procedure prices are published for Upper Valley Medical Center?

Upper Valley Medical Center in Troy, OH currently has 119 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Upper Valley Medical Center's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Upper Valley Medical Center's median negotiated commercial rate is 1.2× the regionally adjusted fair BaseRate benchmark.

What is Upper Valley Medical Center's CMS Care Compare overall star rating?

CMS Care Compare assigns Upper Valley Medical Center an overall hospital quality rating of 4 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Voluntary non-profit - Private 139 Beds · urban Updated: 2026-04-01

Upper Valley Medical Center

3130 N Dixie Highway, Troy, OH 45373 · 119 Priced Procedures · 66% Patient Recommendation

CMS Overall Rating 4 / 5 Stars

Above Fair Market · Negotiate

1.24×vs. Fair Market Price

Typical commercial prices here are +24% above the fair benchmark (1.24×) even after accounting for local nurse/doctor wages and patient complexity.

64/100 · Caution

64/100Self-Pay Cash Beats Insurance 1% of the Time

File Completeness56

Price Logic97

Peer Alignment60

Clean Billing81

Real Cash Discount10

Regional Benchmark Tier

3-Star CMS clinical quality rating paired with 1.24× fair market pricing.

Behavioral Pricing FingerprintUpper-Quartile Spread · +42% Tail Jump

Wide Procedure Spread · Upper-Quartile Skew Pricer

Upper Valley Medical Center prices routine shoppable procedures at 1.6× Medicare (median 1.18× Fair BaseRate) while upper-quartile commercial rates jump +42% to 1.68× Fair BaseRate. Self-pay cash discounts and comparing specific CPT procedure codes before scheduling yield the strongest savings.

#100 of 137 in OH · 72nd State Percentile#2,116 of 3,385 in U.S. · 62nd National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 1.03× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 1% of shoppable procedures (25/100 Cash Honesty)
4-Star CMS clinical rating with 66% patient recommendation (67/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (10.6% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 2.0× markup over Medicare rates
Commercial insurance median sits at 1.18× Fair BaseRate (1.6× Medicare), so insured patients should always compare the self-pay cash price before paying.
Upper-quartile procedures (Q75 1.68×) jump +42% above the median procedure ratio (Q50 1.18×)
Consolidated metro market (HHI 2,470) limits in-network hospital competition (Moderately Concentrated (1,500–2,500))

Front-Door ShoppableElective / Imaging

1.6× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER0.87× Divergence

1.4× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+42% Upper Tail

Q25 1.03× · Q50 1.18× · Q75 1.68×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.

Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×

Front-Door Shoppable CareFront-Door Shoppable

1.6× MedicareGood

Outpatient Surgery & ORBack-Door Captive

2.0× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

2.1× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

2.3× MedicareFair

Inpatient Lab & PathologyBack-Door Captive

2.7× MedicareFair

Specialty & Infusion Drugs (J-Codes)Back-Door Captive

0.6× MedicareGood

Self-Pay Cash Honesty & 501(r)Integrity & Outcomes

1% Cash Edge · 25/100Watchout

CMS Clinical Safety & Star ValueIntegrity & Outcomes

4 CMS · 67/100Fair

Procedure Prices at Upper Valley Medical Center

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 119 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Spinal fusion, single level (inpatient stay) MS-DRG Code: `451`	—	$55,106	$30,775	1.8×
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$39,450	$19,087	unverified
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$37,906	$19,432	unverified
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$32,307	$17,936	1.8×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$17,440	$8,223	unverified
Total hip replacement CPT Code: `27130`	—	$16,745	$13,413	1.2×
Total knee replacement CPT Code: `27447`	—	$16,745	$13,523	1.2×
Gallbladder removal (laparoscopic) CPT Code: `47562`	—	$13,382	$6,109	2.2×
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$7,853	$3,372	2.3×
Bunion correction surgery CPT Code: `28296`	—	$7,853	$3,446	2.3×
Inguinal hernia repair CPT Code: `49505`	—	$7,853	$3,629	2.2×
Cataract surgery with lens implant CPT Code: `66984`	—	$6,522	$2,540	2.6×
Breast lump removal CPT Code: `19120`	—	$6,522	$3,875	1.7×
Upper endoscopy with biopsy CPT Code: `43239`	—	$4,951	$987	unverified
Colonoscopy (diagnostic) CPT Code: `45378`	—	$4,951	$981	unverified
Colonoscopy with biopsy CPT Code: `45380`	—	$4,951	$1,256	unverified
Sleep study (overnight, in lab) CPT Code: `95810`	$4,840	$1,606	$1,021	1.6×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$3,383	$1,022	$583	1.8×
Hospital observation (per hour) HCPCS Code: `G0378`	$641	$641	$86	7.5×
Blood transfusion CPT Code: `36430`	$523	$523	$498	unverified
Ultrasound, leg veins (duplex) CPT Code: `93970`	$2,611	$446	$272	1.6×
Rabies immune globulin HCPCS Code: `90375`	$4,184	$440	$322	1.4×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$3,941	$436	$448	1.0×
MRI, brain (with and without contrast) CPT Code: `70553`	$3,687	$436	$511	0.9×
Breathing treatment (nebulizer) CPT Code: `94640`	$419	$409	$201	2.0×
Neurobehavioral status check CPT Code: `96116`	—	$404	$231	1.7×
Psychotherapy session (45 minutes) CPT Code: `90834`	$502	$332	$166	2.0×
Family therapy session CPT Code: `90847`	$574	$332	$173	1.9×
Psychotherapy session (60 minutes) CPT Code: `90837`	$543	$332	$181	1.8×
Psychiatric evaluation (first visit) CPT Code: `90791`	$725	$332	$185	1.8×
New patient office visit (30-44 min) CPT Code: `99203`	$321	$321	$110	unverified
Office visit, established patient (30-39 min) CPT Code: `99214`	$348	$269	$123	2.2×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$2,175	$273	$303	0.9×
MRI, lower back (no contrast) CPT Code: `72148`	$2,048	$273	$338	0.8×
MRI, brain (no contrast) CPT Code: `70551`	$2,220	$273	$343	0.8×
MRI, knee or other leg joint CPT Code: `73721`	$3,071	$273	$369	0.7×
Psychological testing evaluation CPT Code: `96136`	—	$249	$128	unverified
Office visit, established patient (20-29 min) CPT Code: `99213`	$294	$208	$87	2.4×
Hepatitis B immune globulin HCPCS Code: `90371`	$242	$216	$151	1.4×
CT scan, head (with contrast) CPT Code: `70460`	$2,938	$212	$242	0.9×
CT scan, head (with and without contrast) CPT Code: `70470`	$2,938	$212	$258	0.8×
Group therapy session CPT Code: `90853`	$181	$181	$100	1.8×
Speech therapy (language evaluation) CPT Code: `92507`	$197	$140	$86	1.6×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$474	$110	$64	1.7×
X-ray, pelvis CPT Code: `72170`	$1,057	$129	$110	1.2×
X-ray, lower back CPT Code: `72110`	$1,057	$129	$112	1.2×
Ultrasound, abdomen (limited) CPT Code: `76705`	$1,750	$129	$126	1.0×
Ultrasound, pelvis CPT Code: `76856`	$1,806	$129	$130	1.0×
Ultrasound, thyroid and neck CPT Code: `76536`	$1,635	$129	$132	1.0×
Ultrasound, abdomen (complete) CPT Code: `76700`	$1,806	$129	$134	1.0×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$569	$134	$148	0.9×
Screening mammogram (both breasts) CPT Code: `77067`	$420	$111	$123	0.9×
CT scan, head (no contrast) CPT Code: `70450`	$1,396	$129	$160	0.8×
CT scan, pelvis CPT Code: `72192`	$1,274	$129	$163	0.8×
CT scan, sinuses CPT Code: `70486`	$1,396	$129	$166	0.8×
CT scan, chest (no contrast) CPT Code: `71250`	$1,274	$129	$167	0.8×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$1,274	$129	$168	0.8×
CT scan, neck (cervical spine) CPT Code: `72125`	$1,396	$129	$169	0.8×
Orthotic fitting and training CPT Code: `97760`	$190	$83	$51	1.6×
X-ray, chest (single view) CPT Code: `71045`	$765	$96	$92	1.0×
X-ray, shoulder CPT Code: `73030`	$958	$96	$92	1.0×
X-ray, foot CPT Code: `73630`	$958	$96	$92	1.0×
X-ray, chest (two views) CPT Code: `71046`	$765	$96	$93	1.0×
X-ray, neck (cervical spine) CPT Code: `72040`	$1,057	$96	$93	1.0×
X-ray, hand CPT Code: `73130`	$958	$96	$93	1.0×
X-ray, hip CPT Code: `73502`	$640	$96	$93	1.0×
X-ray, ankle CPT Code: `73610`	$958	$96	$93	1.0×
Typhoid vaccine HCPCS Code: `90675`	$887	$515	$347	unverified
Varicella (chickenpox) vaccine HCPCS Code: `90716`	—	$362	$203	1.8×
Pneumococcal vaccine HCPCS Code: `90732`	$330	$220	$140	unverified
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$313	$188	$111	unverified
Drug screening test HCPCS Code: `G0480`	—	$137	$116	1.2×
Flu vaccine injection HCPCS Code: `G0008`	—	$88	$48	1.8×
Pneumonia vaccine injection HCPCS Code: `G0009`	—	$88	$49	1.8×
Prosthetic fitting and training CPT Code: `97761`	$190	$73	$45	1.6×
Speech therapy (group session) CPT Code: `92508`	$179	$44	$27	1.6×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$168	$64	$40	1.6×
Colorectal cancer screening HCPCS Code: `G0010`	—	$88	$49	unverified
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$198	$60	$38	1.6×
Occupational therapy (self-care training) CPT Code: `97535`	$108	$59	$38	1.6×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$225	$66	$56	1.2×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	—	$59	$39	unverified
Colorectal cancer screening (alternative) HCPCS Code: `G0145`	—	$32	$27	1.2×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$218	$53	$35	unverified
Physical therapy (gait training) CPT Code: `97116`	$198	$53	$33	unverified
Physical therapy (manual therapy) CPT Code: `97140`	$198	$51	$34	unverified
Physical therapy (functional capacity test) CPT Code: `97750`	$225	$61	$38	unverified
Electrical stimulation therapy HCPCS Code: `G0283`	—	$23	$14	1.6×
Blood test, vitamin D CPT Code: `82306`	$417	$36	$31	1.2×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$45	$4	$3	1.3×
Blood test, glucose (blood sugar) CPT Code: `82947`	$56	$5	$4	1.3×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$56	$5	$4	1.3×
Blood test, calcium CPT Code: `82310`	$74	$6	$5	1.2×
Blood test, creatinine (kidney) CPT Code: `82565`	$72	$6	$5	1.2×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$135	$12	$10	1.2×
Blood test, potassium CPT Code: `84132`	$63	$6	$5	1.2×
Blood test, sodium CPT Code: `84295`	$70	$6	$5	1.2×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$152	$13	$11	1.2×
Blood test, PSA (prostate screen) CPT Code: `84153`	$260	$22	$19	1.2×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	—	$23	$20	1.1×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$139	$16	$14	1.1×
Blood test, amylase CPT Code: `82150`	$92	$8	$7	1.1×
Blood test, ferritin (iron stores) CPT Code: `82728`	$191	$16	$14	1.1×
Blood test, lipase CPT Code: `83690`	$96	$8	$7	1.1×
Blood test, magnesium CPT Code: `83735`	$80	$8	$7	1.1×
Hepatitis C antibody test CPT Code: `86803`	$236	$17	$15	1.1×
Blood test, vitamin B12 CPT Code: `82607`	$212	$18	$16	1.1×
Blood test, complete blood count (CBC) CPT Code: `85025`	$137	$9	$8	1.1×
Blood test, basic metabolic panel CPT Code: `80048`	$106	$10	$9	1.1×
Blood test, liver function panel CPT Code: `80076`	$70	$10	$9	1.1×
Blood test, thyroid (TSH) CPT Code: `84443`	$237	$20	$18	1.1×
Diagnostic procedure preparation HCPCS Code: `G0279`	—	$28	$35	0.8×
Flu vaccine (high dose) HCPCS Code: `90656`	$69	$37	$25	unverified
Culture, bacterial CPT Code: `87070`	$74	$10	$9	1.1×
Culture, blood CPT Code: `87040`	$87	$12	$11	1.1×
Blood test, hemoglobin CPT Code: `85018`	$44	$3	$3	1.0×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$71	$5	$5	1.0×
Blood antibody screen CPT Code: `86850`	$519	$12	$46	0.3×
Blood test, clotting time (PTT) CPT Code: `85730`	$107	$7	$6	unverified

Showing top 25 high-impact procedures of 119 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 10.6%

Audit a Bill or Quote at Upper Valley Medical Center (Zero PHI Required)

CMS CCN: 360174

CPT 451

Select Procedure to Audit:

Fair BaseRate™ $30,775

Medicare Rate $23,504

Self-Pay Cash Request Quote

Insurer Median $55,106

1. Amount on Your Bill or Quote ($) Pre-filled with Upper Valley Medical Center’s charged/list benchmark

2. Household Annual Income ($) Screened against 2026 HHS Federal Poverty Guidelines

3. Household Size (1–8) 2026 FPL: $15,650 + $5,500 per additional person

Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $13,979 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $13,979

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (10.6% of gross = $13,979).

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask Upper Valley Medical Center's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$101,479 Above Fair BaseRate

Negotiate Toward $30,775 Fair BaseRate ($23,504 Medicare)

Your bill ($132,254) is $101,479 above the denoised Fair BaseRate ($30,775) and 5.6× the $23,504 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.

IRS Form 990 Schedule H & 26 U.S.C. § 501(r) 501(c)(3) Nonprofit Hospital

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

Free Care Eligibility BenchmarkUp to 200% FPL100% charity write-off income threshold

Discounted Care EligibilityUp to 400% FPLSliding-scale & AGB billing cap tier

Charity Care Share of ExpensesSee Schedule HNet community financial assistance reported

26 U.S.C. § 501(r)(5) AGB Benchmark Method: lookback_commercial_median

Hospital-Specific CMS HCRIS Benchmark (10.6% 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.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑

CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall3/5 Stars (3/5)

Safety Composite67/100

Would Recommend66%

Rated 9 or 10 (HCAHPS)69%

Median ER Wait158 min

Left ER Before Seen1%

30-Day Mortality vs U.S.same

Unplanned Readmissionsame

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)

Central-Line Bloodstream Infectionsame

C. diff Hospital-Onset Infectionbetter

CMS Price Transparency Administrative Enforcement Log

Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Upper Valley Medical Center. Prior administrative notices do not necessarily reflect current compliance status.

2025-06-23·administrative_or_closure
Met Requirements
Recorded
2025-04-08·administrative_or_closure
Met Requirements
Recorded

Source: CMS Hospital Care Compare (953 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Regional Quality & Price Benchmark

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Upper Valley Medical Center.

Price Index: 0.99× regional baseline

Quality: 60/100 CMS composite

Median Household Income$74,175U.S. Census ACS

Local Uninsured Share5.0%Regional ACS estimate

200% FPL (1 Person)$31,920Common free-care ceiling

400% FPL (Family of 4)$128,600Common AGB cap ceiling

45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 64/100 · Caution CMS CCN 360174

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (CMS_45_CFR_180_FILING.json) Verify on CMS Medicare.gov (CCN 360174) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage2026-04-01

Validated Rate Rows1,889 (CMS v3.0.0)

File Integrity DigestVerified · CCN 360174

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.

Submit MRF Update Correction Policy