Pennsylvania / UPMC Horizon
CMS certification 390178 · Greenville, PA · 1 entry in CMS's price-transparency list
UPMC Horizon: charges and Medicare payments
UPMC Horizon reported 292 Medicare inpatient stays across 14 DRGs in 2024. Across them it charged 4.42 times what it was paid — mid-range in Pennsylvania, number 58 of 117 hospitals with at least 100 stays (state median 4.27×, national 4.15×). Its most frequent stay was DRG 291, Heart Failure and Shock with MCC: 39 stays at an average charge of $32,677, 42% below the national average. It also billed 483 outpatient services, charging 8.56 times what Medicare paid.
- 1Medicare inpatient stays 292
- 2Charge ÷ paid, inpatient 4.42×
- 3Rank in PA (highest ratio = 1) 58 of 117
- 4CMS price-transparency actions 1
Inpatient stays
For the 14 DRGs that can be compared with the national average, UPMC Horizon 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 |
|---|---|---|---|---|
| 291 Heart Failure and Shock with MCC | 39 | $32,677 | -42% | $9,450 |
| 193 Simple Pneumonia and Pleurisy with MCC | 38 | $39,918 | -33% | $9,509 |
| 871 Septicemia or Severe Sepsis without MV >96 Hours with MCC | 29 | $45,917 | -49% | $12,618 |
| 470 Major Hip and Knee Joint Replacement or Reattachment of... | 27 | $73,811 | -21% | $13,700 |
| 690 Kidney and Urinary Tract Infections without MCC | 23 | $28,649 | -24% | $6,390 |
| 194 Simple Pneumonia and Pleurisy with CC | 19 | $33,675 | -12% | $6,393 |
| 177 Respiratory Infections and Inflammations with MCC | 18 | $50,313 | -29% | $11,412 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 17 | $29,352 | -27% | $6,246 |
| 603 Cellulitis without MCC | 17 | $25,488 | -32% | $6,757 |
| 189 Pulmonary Edema and Respiratory Failure | 15 | $48,100 | -16% | $8,558 |
| 178 Respiratory Infections and Inflammations with CC | 14 | $34,938 | -23% | $7,639 |
| 190 Chronic Obstructive Pulmonary Disease with MCC | 13 | $38,918 | -23% | $8,070 |
| 312 Syncope and Collapse | 12 | $36,016 | -21% | $6,845 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 11 | $27,840 | -23% | $5,970 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 5 Musculoskeletal Procedures | 79 | $63,444 | $11,740 |
| Level 3 Urology and Related Services | 65 | $16,901 | $1,819 |
| Level 4 Urology and Related Services | 59 | $25,473 | $3,114 |
| Level 5 Urology and Related Services | 48 | $48,404 | $4,589 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 46 | $9,271 | $1,448 |
| Level 1 Nerve Procedures | 41 | $8,215 | $1,725 |
| Comprehensive Observation Services | 33 | $18,162 | $2,386 |
| Level 3 Vascular Procedures | 26 | $22,316 | $2,847 |
| Level 4 Musculoskeletal Procedures | 21 | $52,277 | $6,390 |
| Level 2 Upper GI Procedures | 20 | $14,081 | $1,699 |
| Level 2 Musculoskeletal Procedures | 19 | $10,159 | $1,375 |
| Level 3 Musculoskeletal Procedures | 13 | $31,585 | $2,891 |
| Level 4 Gynecologic Procedures | 13 | $25,741 | $2,793 |
Against the Pennsylvania average
For Heart Failure and Shock with MCC (DRG 291), UPMC Horizon charged $32,677 on average, 43% less than the Pennsylvania average of $57,362, and was paid $9,450 against a state average of $11,112. For Simple Pneumonia and Pleurisy with MCC (DRG 193), UPMC Horizon charged $39,918 on average, 33% less than the Pennsylvania average of $59,404, and was paid $9,509 against a state average of $11,319. For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), UPMC Horizon charged $45,917 on average, 48% less than the Pennsylvania average of $88,167, and was paid $12,618 against a state average of $16,881. For Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC (DRG 470), UPMC Horizon charged $73,811 on average, 4% less than the Pennsylvania average of $77,050, and was paid $13,700 against a state average of $15,450. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $63,444 was 0% below the state average of $63,627. For Level 3 Urology and Related Services (outpatient APC 5373), its average charge of $16,901 was 2% above the state average of $16,557. For Level 4 Urology and Related Services (outpatient APC 5374), its average charge of $25,473 was 0% below the state average of $25,570. For Level 5 Urology and Related Services (outpatient APC 5375), its average charge of $48,404 was 33% above the state average of $36,329.
Price-transparency record
CMS's enforcement list records these actions for a hospital named UPMC Horizon in Greenville, 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 5905)
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.