Pennsylvania / UPMC Somerset
CMS certification 390039 · Somerset, PA · 2 entries in CMS's price-transparency list
UPMC Somerset: charges and Medicare payments
UPMC Somerset reported 156 Medicare inpatient stays across 7 DRGs in 2024. Across them it charged 1.94 times what it was paid — among the lower ratios in Pennsylvania, number 113 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: 50 stays at an average charge of $28,785, 68% below the national average. It also billed 370 outpatient services, charging 5 times what Medicare paid.
- 1Medicare inpatient stays 156
- 2Charge ÷ paid, inpatient 1.94×
- 3Rank in PA (highest ratio = 1) 113 of 117
- 4CMS price-transparency actions 2
Inpatient stays
For the 7 DRGs that can be compared with the national average, UPMC Somerset 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 | 50 | $28,785 | -68% | $15,298 |
| 885 Psychoses | 30 | $20,722 | -53% | $10,882 |
| 193 Simple Pneumonia and Pleurisy with MCC | 19 | $21,209 | -65% | $10,246 |
| 291 Heart Failure and Shock with MCC | 17 | $21,708 | -61% | $10,269 |
| 177 Respiratory Infections and Inflammations with MCC | 14 | $25,982 | -63% | $12,925 |
| 189 Pulmonary Edema and Respiratory Failure | 14 | $16,682 | -71% | $9,447 |
| 872 Septicemia or Severe Sepsis without MV >96 Hours without MCC | 12 | $15,851 | -68% | $8,022 |
Outpatient services
| Service (APC) | Services | Avg charge | Medicare allowed |
|---|---|---|---|
| Comprehensive Observation Services | 84 | $10,410 | $2,596 |
| Level 3 Urology and Related Services | 47 | $11,205 | $1,948 |
| Level 1 Nerve Procedures | 36 | $6,684 | $1,847 |
| Level 4 Urology and Related Services | 28 | $12,077 | $3,335 |
| Level 2 Excision/ Biopsy/ Incision and Drainage | 25 | $5,566 | $1,551 |
| Level 1 Endovascular Procedures | 24 | $13,145 | $3,122 |
| Level 5 Musculoskeletal Procedures | 23 | $42,988 | $12,571 |
| Level 1 Intraocular Procedures | 19 | $11,925 | $2,229 |
| Level 3 Endovascular Procedures | 17 | $41,092 | $10,513 |
| Level 3 Excision/ Biopsy/ Incision and Drainage | 15 | $12,898 | $2,718 |
| Level 5 Urology and Related Services | 15 | $19,094 | $4,950 |
| Level 4 Musculoskeletal Procedures | 13 | $30,800 | $6,843 |
| Level 3 Musculoskeletal Procedures | 12 | $16,633 | $3,096 |
| Level 3 Vascular Procedures | 12 | $12,587 | $3,049 |
Against the Pennsylvania average
For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), UPMC Somerset charged $28,785 on average, 67% less than the Pennsylvania average of $88,167, and was paid $15,298 against a state average of $16,881. For Psychoses (DRG 885), UPMC Somerset charged $20,722 on average, 68% less than the Pennsylvania average of $63,773, and was paid $10,882 against a state average of $13,207. For Simple Pneumonia and Pleurisy with MCC (DRG 193), UPMC Somerset charged $21,209 on average, 64% less than the Pennsylvania average of $59,404, and was paid $10,246 against a state average of $11,319. For Heart Failure and Shock with MCC (DRG 291), UPMC Somerset charged $21,708 on average, 62% less than the Pennsylvania average of $57,362, and was paid $10,269 against a state average of $11,112. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $10,410 was 52% below the state average of $21,732. For Level 3 Urology and Related Services (outpatient APC 5373), its average charge of $11,205 was 32% below the state average of $16,557. For Level 1 Nerve Procedures (outpatient APC 5431), its average charge of $6,684 was 47% below the state average of $12,623. For Level 4 Urology and Related Services (outpatient APC 5374), its average charge of $12,077 was 53% below the state average of $25,570.
Price-transparency record
CMS's enforcement list records these actions for a hospital named UPMC Somerset in Somerset, PA, under the federal hospital price-transparency rule (45 CFR part 180), which requires hospitals to post their standard charges online:
- Warning Notice — 2025-02-13 (CMS case 3074)
- Closure Notice — 2025-03-20 (CMS case 3074)
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.