Upper Valley Medical Center: charges and Medicare payments

Upper Valley Medical Center reported 1,057 Medicare inpatient stays across 40 DRGs in 2024. Across them it charged 4.68 times what it was paid — among the higher ratios in Ohio, number 30 of 104 hospitals with at least 100 stays (state median 4.01×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 127 stays at an average charge of $65,253, 28% below the national average. It also billed 1,442 outpatient services, charging 9.27 times what Medicare paid.

1Medicare inpatient stays 1,057
2Charge ÷ paid, inpatient 4.68×
3Rank in OH (highest ratio = 1) 30 of 104
4CMS price-transparency actions 2

Average charge per stay at Upper Valley Medical Center, its 10 most frequent DRGs, bars to scale. Source: CMS DY2024.

Inpatient stays

For the 40 DRGs that can be compared with the national average, Upper Valley Medical Center charged more than the national average in 0 (0%). Payments follow Medicare's rates, so they usually vary far less than charges.

DRG	Stays	Avg charge	vs US	Avg paid
871 Septicemia or Severe Sepsis without MV >96 Hours with MCC	127	$65,253	-28%	$14,616
291 Heart Failure and Shock with MCC	114	$42,533	-25%	$8,559
193 Simple Pneumonia and Pleurisy with MCC	58	$48,225	-19%	$9,040
683 Renal Failure with CC	42	$27,844	-32%	$6,350
177 Respiratory Infections and Inflammations with MCC	36	$47,173	-33%	$10,817
690 Kidney and Urinary Tract Infections without MCC	36	$23,646	-37%	$5,774
189 Pulmonary Edema and Respiratory Failure	32	$48,287	-16%	$9,330
682 Renal Failure with MCC	31	$46,738	-29%	$10,859
378 Gastrointestinal Hemorrhage with CC	30	$44,031	-9%	$7,244
194 Simple Pneumonia and Pleurisy with CC	27	$34,679	-10%	$5,722
280 Acute Myocardial Infarction, Discharged Alive with MCC	27	$54,392	-28%	$10,946
308 Cardiac Arrhythmia and Conduction Disorders with MCC	26	$39,508	-30%	$9,507
392 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	26	$25,474	-37%	$6,100
641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	26	$31,180	-16%	$5,566
689 Kidney and Urinary Tract Infections with MCC	26	$35,228	-31%	$7,817
309 Cardiac Arrhythmia and Conduction Disorders with CC	25	$30,031	-17%	$5,618
885 Psychoses	25	$27,189	-38%	$10,081
312 Syncope and Collapse	23	$25,908	-43%	$6,181
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	20	$40,308	-33%	$9,764
884 Organic Disturbances and Intellectual Disability	19	$30,899	-50%	$10,398
481 Hip and Femur Procedures except Major Joint with CC	18	$84,296	-16%	$13,985
310 Cardiac Arrhythmia and Conduction Disorders without CC/MCC	17	$21,528	-25%	$5,168
389 Gastrointestinal Obstruction with CC	17	$25,967	-33%	$6,768
811 Red Blood Cell Disorders with MCC	17	$46,206	-32%	$9,647
064 Intracranial Hemorrhage or Cerebral Infarction with MCC	16	$50,267	-50%	$12,202
394 Other Digestive System Diagnoses with CC	16	$36,611	-22%	$7,112
101 Seizures without MCC	15	$24,753	-49%	$6,260
065 Intracranial Hemorrhage or Cerebral Infarction with CC or...	14	$39,515	-29%	$8,923
281 Acute Myocardial Infarction, Discharged Alive with CC	14	$46,026	-9%	$6,337
698 Other Kidney and Urinary Tract Diagnoses with MCC	14	$38,758	-47%	$10,203
175 Pulmonary Embolism with MCC or Acute Cor Pulmonale	13	$51,092	-22%	$9,671
322 Percutaneous Cardiovascular Procedures with Intraluminal...	13	$105,167	-8%	$18,633
377 Gastrointestinal Hemorrhage with MCC	13	$55,098	-35%	$11,723
603 Cellulitis without MCC	13	$26,394	-29%	$6,679
638 Diabetes with CC	13	$32,951	-21%	$6,491
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	13	$35,392	-28%	$7,243
699 Other Kidney and Urinary Tract Diagnoses with CC	12	$27,769	-42%	$7,002
092 Other Disorders of Nervous System with CC	11	$42,622	-17%	$8,184
543 Pathological Fractures and Musculoskeletal and Connective...	11	$34,476	-30%	$6,485
637 Diabetes with MCC	11	$43,565	-34%	$9,901

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Comprehensive Observation Services	333	$21,148	$2,294
Level 2 Upper GI Procedures	243	$9,159	$1,600
Level 1 Intraocular Procedures	146	$12,072	$1,993
Level 2 Excision/ Biopsy/ Incision and Drainage	139	$14,148	$1,363
Level 5 Urology and Related Services	64	$21,625	$4,315
Level 1 Laparoscopy and Related Services	52	$49,979	$4,934
Level 3 Vascular Procedures	50	$19,301	$2,726
Level 1 Endovascular Procedures	42	$32,877	$2,744
Level 2 Musculoskeletal Procedures	41	$8,546	$1,372
Level 4 Urology and Related Services	39	$20,366	$2,920
Level 4 Musculoskeletal Procedures	37	$47,532	$5,987
Level 3 Musculoskeletal Procedures	34	$15,385	$2,769
Level 3 Lower GI Procedures	34	$12,260	$2,400
Level 1 Nerve Procedures	32	$10,911	$1,610
Level 3 Excision/ Biopsy/ Incision and Drainage	30	$23,461	$2,366
Level 5 ENT Procedures	26	$25,594	$4,548
Level 4 Airway Endoscopy	21	$19,400	$3,203
Level 5 Musculoskeletal Procedures	17	$74,940	$11,242
Level 2 Breast/Lymphatic Surgery and Related Procedures	13	$38,329	$5,577
Level 5 Airway Endoscopy	13	$31,307	$5,853
Level 2 Intraocular Procedures	13	$12,658	$3,477
Level 6 Musculoskeletal Procedures	12	$78,605	$15,905
Level 3 Urology and Related Services	11	$19,455	$1,742

Against the Ohio average

For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), Upper Valley Medical Center charged $65,253 on average, 1% more than the Ohio average of $64,290, and was paid $14,616 against a state average of $15,664. For Heart Failure and Shock with MCC (DRG 291), Upper Valley Medical Center charged $42,533 on average, 1% less than the Ohio average of $42,986, and was paid $8,559 against a state average of $10,652. For Simple Pneumonia and Pleurisy with MCC (DRG 193), Upper Valley Medical Center charged $48,225 on average, 16% more than the Ohio average of $41,598, and was paid $9,040 against a state average of $10,716. For Renal Failure with CC (DRG 683), Upper Valley Medical Center charged $27,844 on average, 4% less than the Ohio average of $28,967, and was paid $6,350 against a state average of $7,599. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $21,148 was 24% above the state average of $17,044. For Level 2 Upper GI Procedures (outpatient APC 5302), its average charge of $9,159 was 12% below the state average of $10,363. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $12,072 was 14% above the state average of $10,597. For Level 2 Excision/ Biopsy/ Incision and Drainage (outpatient APC 5072), its average charge of $14,148 was 39% above the state average of $10,162.

Price-transparency record

CMS's enforcement list records these actions for a hospital named Upper Valley Medical Center in Troy, OH, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:

Met Requirements — 2025-04-08 (CMS case 3660)
Met Requirements — 2025-06-23 (CMS case 5282)

A warning notice or corrective-action request is not a finding of wrongdoing; "Met Requirements" and closure notices record that CMS's review ended. Matched to this hospital by exact name, city and state.

Charges are the hospital's list prices averaged over its 2024 Medicare cases; payments are what those cases actually brought in. Neither is what you will pay. For a planned procedure, ask the hospital for its price estimate or, if you are uninsured or self-paying, a good-faith estimate.

Sources: CMS Medicare Inpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Medicare Outpatient Hospitals — by Provider and Service / by Geography and Service, data year 2024; CMS Hospital Price Transparency Enforcement Activities and Outcomes, July 2026. Checked 2026-10-24. Methodology.