Pennsylvania / UPMC East
CMS certification 390328 · Monroeville, PA · 1 entry in CMS's price-transparency list
UPMC East: charges and Medicare payments
UPMC East reported 691 Medicare inpatient stays across 27 DRGs in 2024. Across them it charged 6.9 times what it was paid — among the higher ratios in Pennsylvania, number 21 of 117 hospitals with at least 100 stays (state median 4.27×, national 4.15×). Its most frequent stay was DRG 871, Septicemia or Severe Sepsis without MV >96 Hours with MCC: 105 stays at an average charge of $94,903, 5% above the national average. It also billed 1,216 outpatient services, charging 10.22 times what Medicare paid.
- 1Medicare inpatient stays 691
- 2Charge ÷ paid, inpatient 6.9×
- 3Rank in PA (highest ratio = 1) 21 of 117
- 4CMS price-transparency actions 1
Inpatient stays
For the 27 DRGs that can be compared with the national average, UPMC East charged more than the national average in 20 (74%). 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 | 105 | $94,903 | +5% | $13,965 |
| 291 Heart Failure and Shock with MCC | 88 | $54,905 | -3% | $8,885 |
| 177 Respiratory Infections and Inflammations with MCC | 47 | $82,250 | +17% | $11,401 |
| 690 Kidney and Urinary Tract Infections without MCC | 42 | $49,017 | +30% | $6,952 |
| 193 Simple Pneumonia and Pleurisy with MCC | 37 | $62,734 | +5% | $9,326 |
| 378 Gastrointestinal Hemorrhage with CC | 29 | $53,805 | +11% | $7,148 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 28 | $53,021 | +32% | $5,600 |
| 280 Acute Myocardial Infarction, Discharged Alive with MCC | 24 | $63,760 | -16% | $11,140 |
| 683 Renal Failure with CC | 24 | $36,883 | -9% | $6,514 |
| 470 Major Hip and Knee Joint Replacement or Reattachment of... | 23 | $100,299 | +8% | $13,290 |
| 189 Pulmonary Edema and Respiratory Failure | 19 | $61,175 | +6% | $8,436 |
| 603 Cellulitis without MCC | 19 | $40,377 | +8% | $6,491 |
| 682 Renal Failure with MCC | 19 | $72,026 | +9% | $10,364 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 18 | $39,651 | +10% | $5,476 |
| 640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 16 | $56,847 | -6% | $9,461 |
| 689 Kidney and Urinary Tract Infections with MCC | 15 | $53,371 | +4% | $7,946 |
| 377 Gastrointestinal Hemorrhage with MCC | 14 | $97,113 | +14% | $12,751 |
| 552 Medical Back Problems without MCC | 14 | $29,608 | -39% | $6,839 |
| 853 Infectious and Parasitic Diseases with O.R. Procedures with... | 14 | $199,876 | -13% | $33,391 |
| 065 Intracranial Hemorrhage or Cerebral Infarction with CC or... | 13 | $56,503 | +1% | $9,426 |
| 178 Respiratory Infections and Inflammations with CC | 13 | $66,439 | +47% | $7,338 |
| 322 Percutaneous Cardiovascular Procedures with Intraluminal... | 13 | $136,070 | +19% | $15,121 |
| 389 Gastrointestinal Obstruction with CC | 12 | $36,759 | -6% | $5,888 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 12 | $61,327 | +25% | $7,487 |
| 194 Simple Pneumonia and Pleurisy with CC | 11 | $44,890 | +17% | $5,798 |
| 286 Circulatory Disorders except AMI, with Cardiac... | 11 | $124,059 | +11% | $15,629 |
| 641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 11 | $58,484 | +58% | $5,807 |
Outpatient services
Against the Pennsylvania average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), UPMC East charged $94,903 on average, 8% more than the Pennsylvania average of $88,167, and was paid $13,965 against a state average of $16,881. For Heart Failure and Shock with MCC (DRG 291), UPMC East charged $54,905 on average, 4% less than the Pennsylvania average of $57,362, and was paid $8,885 against a state average of $11,112. For Respiratory Infections and Inflammations with MCC (DRG 177), UPMC East charged $82,250 on average, 14% more than the Pennsylvania average of $72,025, and was paid $11,401 against a state average of $14,034. For Kidney and Urinary Tract Infections without MCC (DRG 690), UPMC East charged $49,017 on average, 34% more than the Pennsylvania average of $36,664, and was paid $6,952 against a state average of $7,034. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $17,480 was 20% below the state average of $21,732. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $18,439 was 28% above the state average of $14,403. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $81,658 was 28% above the state average of $63,627. For Level 4 Musculoskeletal Procedures (outpatient APC 5114), its average charge of $80,417 was 69% above the state average of $47,486.
Price-transparency record
CMS's enforcement list records these actions for a hospital named UPMC East in Monroeville, PA, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Met Requirements — 2025-07-21 (CMS case 5895)
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.