Pennsylvania / UPMC Northwest
CMS certification 390091 · Seneca, PA
UPMC Northwest: charges and Medicare payments
UPMC Northwest reported 552 Medicare inpatient stays across 22 DRGs in 2024. Across them it charged 3.7 times what it was paid — among the lower ratios in Pennsylvania, number 79 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: 79 stays at an average charge of $28,829, 49% below the national average. It also billed 689 outpatient services, charging 6.95 times what Medicare paid.
- 1Medicare inpatient stays 552
- 2Charge ÷ paid, inpatient 3.7×
- 3Rank in PA (highest ratio = 1) 79 of 117
- 4CMS price-transparency actions 0
Inpatient stays
For the 22 DRGs that can be compared with the national average, UPMC Northwest charged more than the national average in 1 (5%). 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 | 79 | $28,829 | -49% | $8,923 |
| 871 Septicemia or Severe Sepsis without MV >96 Hours with MCC | 68 | $48,653 | -46% | $13,002 |
| 193 Simple Pneumonia and Pleurisy with MCC | 44 | $41,918 | -30% | $9,265 |
| 177 Respiratory Infections and Inflammations with MCC | 36 | $42,441 | -40% | $11,166 |
| 690 Kidney and Urinary Tract Infections without MCC | 31 | $19,464 | -49% | $5,790 |
| 683 Renal Failure with CC | 30 | $22,707 | -44% | $6,457 |
| 194 Simple Pneumonia and Pleurisy with CC | 25 | $25,050 | -35% | $5,986 |
| 189 Pulmonary Edema and Respiratory Failure | 23 | $32,789 | -43% | $8,692 |
| 392 Esophagitis, Gastroenteritis and Miscellaneous Digestive... | 21 | $20,159 | -50% | $5,510 |
| 309 Cardiac Arrhythmia and Conduction Disorders with CC | 19 | $24,678 | -32% | $5,344 |
| 178 Respiratory Infections and Inflammations with CC | 18 | $29,277 | -35% | $7,055 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 18 | $25,888 | -47% | $7,250 |
| 641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and... | 16 | $22,118 | -40% | $5,670 |
| 682 Renal Failure with MCC | 16 | $32,156 | -51% | $9,944 |
| 885 Psychoses | 16 | $46,445 | +5% | $12,972 |
| 065 Intracranial Hemorrhage or Cerebral Infarction with CC or... | 15 | $34,521 | -38% | $7,107 |
| 280 Acute Myocardial Infarction, Discharged Alive with MCC | 15 | $32,749 | -57% | $10,869 |
| 190 Chronic Obstructive Pulmonary Disease with MCC | 13 | $29,955 | -41% | $7,790 |
| 312 Syncope and Collapse | 13 | $21,962 | -52% | $6,269 |
| 552 Medical Back Problems without MCC | 12 | $20,606 | -58% | $6,931 |
| 603 Cellulitis without MCC | 12 | $20,704 | -44% | $6,320 |
| 689 Kidney and Urinary Tract Infections with MCC | 12 | $28,341 | -45% | $8,278 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Level 3 Urology and Related Services | 109 | $14,502 | $1,819 |
| Comprehensive Observation Services | 93 | $17,836 | $2,361 |
| Level 4 Urology and Related Services | 83 | $14,327 | $3,035 |
| Level 2 Urology and Related Services | 76 | $8,859 | $610 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 47 | $12,116 | $1,448 |
| Level 5 Urology and Related Services | 47 | $19,202 | $4,543 |
| Level 1 Intraocular Procedures | 42 | $8,529 | $2,081 |
| Level 1 Nerve Procedures | 37 | $14,025 | $1,725 |
| Level 3 Vascular Procedures | 26 | $12,880 | $2,847 |
| Level 3 Excision/ Biopsy/ Incision and Drainage | 21 | $15,321 | $2,538 |
| Level 5 Musculoskeletal Procedures | 21 | $39,192 | $11,740 |
| Level 2 Vascular Procedures | 19 | $10,766 | $1,430 |
| Level 3 Musculoskeletal Procedures | 16 | $13,389 | $2,891 |
| Level 1 Abdominal/Peritoneal/Biliary and Related Procedures | 14 | $8,725 | $3,090 |
| Level 1 Laparoscopy and Related Services | 14 | $12,618 | $5,154 |
| Level 4 Gynecologic Procedures | 13 | $8,275 | $2,792 |
| Level 2 Musculoskeletal Procedures | 11 | $8,216 | $1,436 |
Against the Pennsylvania average
For Heart Failure and Shock with MCC (DRG 291), UPMC Northwest charged $28,829 on average, 50% less than the Pennsylvania average of $57,362, and was paid $8,923 against a state average of $11,112. For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), UPMC Northwest charged $48,653 on average, 45% less than the Pennsylvania average of $88,167, and was paid $13,002 against a state average of $16,881. For Simple Pneumonia and Pleurisy with MCC (DRG 193), UPMC Northwest charged $41,918 on average, 29% less than the Pennsylvania average of $59,404, and was paid $9,265 against a state average of $11,319. For Respiratory Infections and Inflammations with MCC (DRG 177), UPMC Northwest charged $42,441 on average, 41% less than the Pennsylvania average of $72,025, and was paid $11,166 against a state average of $14,034. For Level 3 Urology and Related Services (outpatient APC 5373), its average charge of $14,502 was 12% below the state average of $16,557. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $17,836 was 18% below the state average of $21,732. For Level 4 Urology and Related Services (outpatient APC 5374), its average charge of $14,327 was 44% below the state average of $25,570. For Level 2 Urology and Related Services (outpatient APC 5372), its average charge of $8,859 was 103% above the state average of $4,364.
Price-transparency record
No action in CMS's price-transparency enforcement list (July 2026) matches this hospital's exact name, city and state. That can mean CMS has not reviewed it, or that it is listed under a different name.
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.