Pennsylvania / UPMC St Margaret

CMS certification 390102 · Pittsburgh, PA · 1 entry in CMS's price-transparency list

UPMC St Margaret: charges and Medicare payments

UPMC St Margaret reported 817 Medicare inpatient stays across 34 DRGs in 2024. Across them it charged 5.94 times what it was paid — among the higher ratios in Pennsylvania, number 32 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: 93 stays at an average charge of $54,362, 4% below the national average. It also billed 1,593 outpatient services, charging 10.11 times what Medicare paid.

1Medicare inpatient stays 817
2Charge ÷ paid, inpatient 5.94×
3Rank in PA (highest ratio = 1) 32 of 117
4CMS price-transparency actions 1

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

Inpatient stays

For the 34 DRGs that can be compared with the national average, UPMC St Margaret charged more than the national average in 19 (56%). 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	93	$54,362	-4%	$10,486
871 Septicemia or Severe Sepsis without MV >96 Hours with MCC	69	$86,652	-4%	$15,480
470 Major Hip and Knee Joint Replacement or Reattachment of...	51	$105,859	+14%	$14,809
177 Respiratory Infections and Inflammations with MCC	47	$72,493	+3%	$13,564
392 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	41	$34,645	-14%	$6,973
690 Kidney and Urinary Tract Infections without MCC	29	$41,134	+9%	$6,516
189 Pulmonary Edema and Respiratory Failure	27	$51,986	-10%	$10,903
193 Simple Pneumonia and Pleurisy with MCC	27	$67,357	+13%	$10,502
460 Spinal Fusion except Cervical without MCC	27	$191,233	+12%	$27,788
641 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	26	$42,940	+16%	$7,000
683 Renal Failure with CC	25	$45,667	+12%	$7,999
603 Cellulitis without MCC	24	$33,346	-11%	$7,293
682 Renal Failure with MCC	22	$67,554	+2%	$10,705
194 Simple Pneumonia and Pleurisy with CC	20	$51,143	+33%	$7,316
552 Medical Back Problems without MCC	20	$37,633	-23%	$7,648
467 Revision of Hip or Knee Replacement with CC	19	$127,838	-19%	$23,658
853 Infectious and Parasitic Diseases with O.R. Procedures with...	18	$298,717	+30%	$45,477
178 Respiratory Infections and Inflammations with CC	17	$42,302	-7%	$8,076
377 Gastrointestinal Hemorrhage with MCC	17	$103,529	+21%	$16,263
481 Hip and Femur Procedures except Major Joint with CC	17	$104,349	+4%	$16,675
378 Gastrointestinal Hemorrhage with CC	16	$60,204	+24%	$8,564
872 Septicemia or Severe Sepsis without MV >96 Hours without MCC	16	$55,986	+14%	$7,987
308 Cardiac Arrhythmia and Conduction Disorders with MCC	15	$46,274	-18%	$10,590
640 Miscellaneous Disorders of Nutrition, Metabolism, Fluids and...	15	$44,762	-26%	$10,923
309 Cardiac Arrhythmia and Conduction Disorders with CC	13	$33,454	-7%	$6,294
554 Bone Diseases and Arthropathies without MCC	13	$37,603	-1%	$7,074
563 Fracture, Sprain, Strain and Dislocation except Femur, Hip,...	13	$34,646	-19%	$7,155
312 Syncope and Collapse	12	$45,449	0%	$7,299
391 Esophagitis, Gastroenteritis and Miscellaneous Digestive...	12	$113,762	+86%	$15,969
468 Revision of Hip or Knee Replacement without CC/MCC	12	$118,179	-5%	$19,102
617 Amputation of Lower Limb for Endocrine, Nutritional and...	11	$92,098	+6%	$16,446
637 Diabetes with MCC	11	$91,192	+37%	$12,655
638 Diabetes with CC	11	$58,109	+39%	$8,096
660 Kidney and Ureter Procedures for Non-Neoplasm with CC	11	$74,712	+11%	$12,321

Outpatient services

Service (APC)	Services	Avg charge	Medicare allowed
Level 1 Intraocular Procedures	282	$21,697	$2,076
Level 5 Musculoskeletal Procedures	215	$76,709	$11,693
Comprehensive Observation Services	161	$26,329	$2,409
Level 1 Nerve Procedures	114	$14,068	$1,713
Level 4 Musculoskeletal Procedures	92	$61,344	$6,334
Level 3 Musculoskeletal Procedures	83	$33,967	$2,839
Level 5 Urology and Related Services	75	$54,933	$4,622
Level 2 Musculoskeletal Procedures	68	$14,660	$1,419
Level 2 Urology and Related Services	61	$4,696	$610
Level 2 Excision/ Biopsy/ Incision and Drainage	51	$11,880	$1,377
Level 1 Laparoscopy and Related Services	51	$47,665	$5,078
Level 3 Vascular Procedures	48	$20,248	$2,847
Level 6 Musculoskeletal Procedures	42	$95,505	$16,610
Level 4 Urology and Related Services	38	$37,074	$3,114
Level 3 Urology and Related Services	35	$12,580	$1,819
Level 2 Upper GI Procedures	27	$22,230	$1,699
Level 2 Endovascular Procedures	26	$46,597	$5,105
Level 2 Intraocular Procedures	26	$33,543	$3,520
Level 3 Lower GI Procedures	20	$26,802	$2,506
Level 4 Vascular Procedures	18	$37,403	$4,090
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures	17	$38,537	$3,090
Level 3 Excision/ Biopsy/ Incision and Drainage	16	$23,133	$2,538
Level 2 Vascular Procedures	15	$7,389	$1,354
Level 5 ENT Procedures	12	$49,706	$4,918

Against the Pennsylvania average

For Heart Failure and Shock with MCC (DRG 291), UPMC St Margaret charged $54,362 on average, 5% less than the Pennsylvania average of $57,362, and was paid $10,486 against a state average of $11,112. For Septicemia or Severe Sepsis without MV >96 Hours with MCC (DRG 871), UPMC St Margaret charged $86,652 on average, 2% less than the Pennsylvania average of $88,167, and was paid $15,480 against a state average of $16,881. For Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without MCC (DRG 470), UPMC St Margaret charged $105,859 on average, 37% more than the Pennsylvania average of $77,050, and was paid $14,809 against a state average of $15,450. For Respiratory Infections and Inflammations with MCC (DRG 177), UPMC St Margaret charged $72,493 on average, 1% more than the Pennsylvania average of $72,025, and was paid $13,564 against a state average of $14,034. For Level 1 Intraocular Procedures (outpatient APC 5491), its average charge of $21,697 was 51% above the state average of $14,403. For Level 5 Musculoskeletal Procedures (outpatient APC 5115), its average charge of $76,709 was 21% above the state average of $63,627. For Comprehensive Observation Services (outpatient APC 8011), its average charge of $26,329 was 21% above the state average of $21,732. For Level 1 Nerve Procedures (outpatient APC 5431), its average charge of $14,068 was 11% above the state average of $12,623.

Price-transparency record

CMS's enforcement list records these actions for a hospital named UPMC St Margaret in Pittsburgh, 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 5896)

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.