Potomac Valley Hospital
100 Pin Oak Lane, Keyser, WV 26726 · 113 Priced Procedures · 81% Patient Recommendation
Typical commercial prices here are +50% above the fair benchmark (1.50×) even after accounting for local nurse/doctor wages and patient complexity.
4-Star CMS clinical quality rating paired with 1.50× fair market pricing.
Loss-Leader / Captive Ancillary Cross-Subsidizer
Potomac Valley Hospital prices routine shoppable procedures near 1.6× Medicare (p50 1.51×) while skewing captive emergency, lab, and upper-quartile codes to 3.3× Medicare (p75 1.57×, +4% upper-tail jump). Patients scheduling elective outpatient care can capture competitive rates, but emergency and ancillary bills require strict line-item auditing.
Where They're Good (Patient & Payer Edge)
- Bottom-quartile procedures (Q25) price at 1.37× the peer BaseRate benchmark
- Self-pay cash beats commercial insurance on 90% of shoppable procedures (99/100 Cash Honesty)
- 1-Star CMS clinical rating with 81% patient recommendation (75/100 safety score)
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (62.9% AGB cap)
Where You Can Get Burned (Markup Traps)
- Even at low-cost facilities (1.50× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Captive ER (5.1×) & laboratory (0.8×) services average 2.06× higher multiples than routine shoppable care (1.6×)
- Even at low-cost facilities (1.50× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Consolidated metro market (HHI 8,101) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))
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 Potomac Valley Hospital
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 113 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| C-section delivery (full package) CPT Code: 59510 | $2,947 | 1.0× |
| Vaginal delivery (full package) CPT Code: 59400 | $2,615 | 1.0× |
| Total knee replacement CPT Code: 27447 | $2,293 | 0.2× |
| Total hip replacement CPT Code: 27130 | $1,420 | 0.1× |
| Trauma team activation HCPCS Code: G0390 | $1,277 | 0.9× |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $1,040 | 0.2× |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $923 | 0.3× |
| MRI, brain (with and without contrast) CPT Code: 70553 | $814 | 1.6× |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $753 | 1.7× |
| Colonoscopy with biopsy CPT Code: 45380 | $710 | 0.6× |
| Inguinal hernia repair CPT Code: 49505 | $723 | 0.2× |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $661 | 2.2× |
| Colonoscopy (diagnostic) CPT Code: 45378 | $650 | 0.7× |
| CT scan, head (with contrast) CPT Code: 70460 | $596 | 2.5× |
| MRI, lower back (no contrast) CPT Code: 72148 | $605 | 1.8× |
| MRI, knee or other leg joint CPT Code: 73721 | $596 | 1.6× |
| MRI, brain (no contrast) CPT Code: 70551 | $535 | 1.6× |
| Bunion correction surgery CPT Code: 28296 | $558 | 0.2× |
| Upper endoscopy with biopsy CPT Code: 43239 | $527 | 0.5× |
| Cataract surgery with lens implant CPT Code: 66984 | $508 | 0.2× |
| Breast lump removal CPT Code: 19120 | $466 | 0.1× |
| Blood transfusion CPT Code: 36430 | $423 | 0.8× |
| CT scan, head (with and without contrast) CPT Code: 70470 | $396 | 1.5× |
| Injection procedure for pain management HCPCS Code: G0260 | $380 | 0.4× |
| CT scan, pelvis CPT Code: 72192 | $336 | 2.1× |
Audit a Bill or Quote at Potomac Valley Hospital (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $3,709
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (62.9% of gross = $3,709).
Self-Pay Cash Rate ($2,947) Beats Your Bill
Potomac Valley Hospital's published 45 CFR § 180 self-pay cash rate is $2,947 (vs. $2,947 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Negotiate Toward $2,975 Fair BaseRate ($2,473 Medicare)
Your bill ($5,893) is $2,918 above the denoised Fair BaseRate ($2,975) and 2.4× the $2,473 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (62.9% 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
Healthcare-Associated Infections (CDC NHSN / CMS HAI)
1.00 SIR = National Predicted Baseline (Lower Is Safer)Source: CMS Hospital Care Compare (231 completed HCAHPS patient surveys). 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 Potomac Valley Hospital.
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.