UPMC Pinnacle Hospitals: charges and Medicare payments

UPMC Pinnacle Hospitals reported 5,957 Medicare inpatient stays across 164 DRGs in 2024. Across them it charged 4.13 times what it was paid — mid-range in Pennsylvania, number 64 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: 496 stays at an average charge of $50,605, 10% below the national average. It also billed 6,783 outpatient services, charging 5.78 times what Medicare paid.

1Medicare inpatient stays 5,957
2Charge ÷ paid, inpatient 4.13×
3Rank in PA (highest ratio = 1) 64 of 117
4CMS price-transparency actions 0

Average charge per stay at UPMC Pinnacle Hospitals, its 10 most frequent DRGs, bars to scale. Source: CMS DY2024.

Inpatient stays

For the 164 DRGs that can be compared with the national average, UPMC Pinnacle Hospitals charged more than the national average in 7 (4%). 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	496	$50,605	-10%	$11,260
871 Septicemia or Severe Sepsis without MV >96 Hours with MCC	458	$70,586	-22%	$16,689
470 Major Hip and Knee Joint Replacement or Reattachment of...	117	$50,806	-45%	$16,138
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	109	$38,451	-22%	$9,113
266 Endovascular Cardiac Valve Replacement and Supplement...	106	$154,566	-46%	$48,680
378 Gastrointestinal Hemorrhage with CC	102	$43,445	-11%	$8,582
683 Renal Failure with CC	97	$32,938	-19%	$8,259
392 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	92	$31,167	-22%	$7,036
690 Kidney and Urinary Tract Infections without MCC	90	$31,732	-16%	$7,091
177 Respiratory Infections and Inflammations with MCC	85	$59,442	-16%	$14,747
309 Cardiac Arrhythmia and Conduction Disorders with CC	85	$30,626	-15%	$6,783
065 Intracranial Hemorrhage or Cerebral Infarction with CC or...	82	$48,753	-13%	$9,182
853 Infectious and Parasitic Diseases with O.R. Procedures with...	75	$164,009	-28%	$40,201
236 Coronary Bypass without Cardiac Catheterization without MCC	74	$134,719	-36%	$34,922
556 Signs and Symptoms of Musculoskeletal System and Connective...	73	$31,357	-22%	$7,374
312 Syncope and Collapse	69	$35,752	-21%	$7,442
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	69	$49,708	-18%	$11,335
286 Circulatory Disorders except AMI, with Cardiac...	68	$77,856	-31%	$18,870
267 Endovascular Cardiac Valve Replacement and Supplement...	66	$149,285	-33%	$38,023
064 Intracranial Hemorrhage or Cerebral Infarction with MCC	63	$77,212	-23%	$16,483
308 Cardiac Arrhythmia and Conduction Disorders with MCC	63	$51,271	-9%	$10,525
641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	61	$30,192	-19%	$7,089
689 Kidney and Urinary Tract Infections with MCC	61	$45,160	-12%	$9,705
603 Cellulitis without MCC	60	$32,384	-13%	$7,894
698 Other Kidney and Urinary Tract Diagnoses with MCC	60	$47,353	-36%	$13,096
194 Simple Pneumonia and Pleurisy with CC	57	$32,680	-15%	$7,544
377 Gastrointestinal Hemorrhage with MCC	57	$75,244	-12%	$15,940
274 Percutaneous and Other Intracardiac Procedures without MCC	56	$94,239	-40%	$25,212
193 Simple Pneumonia and Pleurisy with MCC	55	$54,091	-9%	$11,427
699 Other Kidney and Urinary Tract Diagnoses with CC	51	$38,434	-19%	$9,330
287 Circulatory Disorders except AMI, with Cardiac...	49	$42,976	-33%	$9,241
330 Major Small and Large Bowel Procedures with CC	49	$85,794	-28%	$19,855
460 Spinal Fusion except Cervical without MCC	48	$87,114	-49%	$29,478
522 Hip Replacement with Principal Diagnosis of Hip Fracture...	48	$67,233	-34%	$17,538
552 Medical Back Problems without MCC	43	$30,332	-38%	$8,017
057 Degenerative Nervous System Disorders without MCC	41	$48,437	-14%	$12,051
189 Pulmonary Edema and Respiratory Failure	41	$57,822	0%	$10,626
310 Cardiac Arrhythmia and Conduction Disorders without CC/MCC	41	$27,972	-3%	$5,019
481 Hip and Femur Procedures except Major Joint with CC	41	$64,704	-36%	$17,366
682 Renal Failure with MCC	41	$65,376	-1%	$13,440
322 Percutaneous Cardiovascular Procedures with Intraluminal...	40	$71,357	-38%	$14,966
069 Transient Ischemia without Thrombolytic	38	$34,786	-31%	$6,721
220 Cardiac Valve and Other Major Cardiothoracic Procedures...	37	$166,317	-40%	$43,132
391 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	37	$54,848	-10%	$11,123
812 Red Blood Cell Disorders without MCC	37	$40,887	-8%	$8,146
468 Revision of Hip or Knee Replacement without CC/MCC	36	$68,372	-45%	$22,354
638 Diabetes with CC	36	$32,264	-23%	$7,768
329 Major Small and Large Bowel Procedures with MCC	35	$154,636	-28%	$37,961
314 Other Circulatory System Diagnoses with MCC	34	$78,119	-18%	$18,784
092 Other Disorders of Nervous System with CC	33	$41,697	-19%	$8,692
178 Respiratory Infections and Inflammations with CC	33	$37,183	-18%	$8,134
811 Red Blood Cell Disorders with MCC	33	$54,658	-20%	$12,180
321 Percutaneous Cardiovascular Procedures with Intraluminal...	31	$114,186	-30%	$23,999
394 Other Digestive System Diagnoses with CC	31	$37,988	-19%	$8,299
884 Organic Disturbances and Intellectual Disability	31	$48,656	-22%	$14,524
025 Craniotomy and Endovascular Intracranial Procedures with MCC	30	$184,534	-20%	$39,221
175 Pulmonary Embolism with MCC or Acute Cor Pulmonale	30	$59,606	-9%	$13,033
243 Permanent Cardiac Pacemaker Implant with CC	30	$91,406	-18%	$18,281
652 Kidney Transplant	30	$265,196	-21%	$42,165
190 Chronic Obstructive Pulmonary Disease with MCC	29	$51,056	+1%	$10,117

Showing the 60 most frequent of 164 DRGs.

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Comprehensive Observation Services	1,049	$16,097	$2,433
Level 2 Urology and Related Services	697	$1,585	$280
Level 3 Urology and Related Services	623	$7,620	$1,245
Level 5 Musculoskeletal Procedures	578	$36,989	$11,761
Level 1 Endovascular Procedures	372	$17,992	$2,913
Level 4 Urology and Related Services	321	$16,625	$2,677
Level 2 Excision/ Biopsy/ Incision and Drainage	259	$9,401	$1,441
Level 3 Vascular Procedures	221	$18,627	$2,846
Level 1 Laparoscopy and Related Services	205	$32,164	$5,110
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures	164	$19,097	$3,100
Level 4 Musculoskeletal Procedures	162	$28,120	$6,411
Level 5 Urology and Related Services	162	$19,334	$3,963
Level 3 Electrophysiologic Procedures	142	$99,421	$21,229
Level 3 Endovascular Procedures	139	$55,973	$9,791
Level 2 Upper GI Procedures	138	$11,231	$1,695
Level 2 Endovascular Procedures	107	$28,902	$5,046
Level 6 Musculoskeletal Procedures	98	$51,041	$16,511
Level 3 Pacemaker and Similar Procedures	92	$52,400	$9,562
Level 3 Excision/ Biopsy/ Incision and Drainage	90	$19,010	$2,501
Level 2 Vascular Procedures	79	$6,975	$1,435
Level 3 Musculoskeletal Procedures	73	$14,462	$2,901
Level 5 Airway Endoscopy	73	$27,687	$5,999
Level 1 Nerve Procedures	71	$9,161	$1,730
Level 2 Laparoscopy and Related Services	69	$54,824	$8,999
Level 2 Musculoskeletal Procedures	68	$7,773	$1,440

Against the Pennsylvania average

For Heart Failure and Shock with MCC (DRG 291), UPMC Pinnacle Hospitals charged $50,605 on average, 12% less than the Pennsylvania average of $57,362, and was paid $11,260 against a state average of $11,112. For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), UPMC Pinnacle Hospitals charged $70,586 on average, 20% less than the Pennsylvania average of $88,167, and was paid $16,689 against a state average of $16,881. For Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC (DRG 470), UPMC Pinnacle Hospitals charged $50,806 on average, 34% less than the Pennsylvania average of $77,050, and was paid $16,138 against a state average of $15,450. For Septicemia or Severe Sepsis without MV >96 Hours without MCC (DRG 872), UPMC Pinnacle Hospitals charged $38,451 on average, 23% less than the Pennsylvania average of $49,758, and was paid $9,113 against a state average of $9,077. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $16,097 was 26% below the state average of $21,732. For Level 2 Urology and Related Services (outpatient APC 5372), its average charge of $1,585 was 64% below the state average of $4,364. For Level 3 Urology and Related Services (outpatient APC 5373), its average charge of $7,620 was 54% below the state average of $16,557. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $36,989 was 42% below the state average of $63,627.

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.