85/100
#204 nationally
Upmc Somerset
225 South Center Avenue, Somerset, PA 15501 · (814) 443-5000
Charges close to what care is actually paid for
For every $1 of care Medicare actually paid for here, Upmc Somerset billed $2.84 in list charges. That gap does not change a Medicare patient's bill — but it is where an uninsured or out-of-network bill starts.
- Charge-to-payment
- 2.8x
- volume-weighted across all its priced work
- Procedures priced
- 21
- inpatient and outpatient combined
- Rank in PA
- #9
- lower markup ranks higher
- CMS quality stars
- 4/5
- shown for context, not in the grade
How this grade was reached
Each component is scored against every other U.S. hospital in the same federal files, so the grade is a position in the country, not a pass mark we invented.
Better than 90% of U.S. hospitals.
Better than 83% of U.S. hospitals.
Better than 84% of U.S. hospitals.
Better than 78% of U.S. hospitals.
What this hospital treats most
The ten procedures it billed Medicare for most often, with its charge beside the national middle.
| Procedure | Patients | Charged | Actually paid | vs national |
|---|---|---|---|---|
|
Comprehensive Observation Services
APC 8011 · Hospital outpatient visit |
84 | $10,410 | $2,596 | -46% |
|
Sepsis (severe)
MS-DRG 871 · Inpatient stay |
50 | $28,785 | $15,298 | -56% |
|
Level 3 Urology and Related Services
APC 5373 · Hospital outpatient visit |
47 | $11,205 | $1,948 | -13% |
|
Level 1 Nerve Procedures
APC 5431 · Hospital outpatient visit |
36 | $6,684 | $1,847 | -41% |
|
Psychoses
MS-DRG 885 · Inpatient stay |
30 | $20,722 | $10,882 | -43% |
|
Level 4 Urology and Related Services
APC 5374 · Hospital outpatient visit |
28 | $12,077 | $3,335 | -42% |
|
Level 2 Excision/ Biopsy/ Incision and Drainage
APC 5072 · Hospital outpatient visit |
25 | $5,566 | $1,551 | -45% |
|
Level 1 Endovascular Procedures
APC 5191 · Hospital outpatient visit |
24 | $13,145 | $3,122 | -48% |
|
Level 5 Musculoskeletal Procedures
APC 5115 · Hospital outpatient visit |
23 | $42,988 | $12,571 | -31% |
|
Pneumonia (severe)
MS-DRG 193 · Inpatient stay |
19 | $21,209 | $10,246 | -54% |
Where its charges run furthest above the national middle
Only procedures it performed at least eleven times, so a single unusual case cannot produce the headline.
| Procedure | Charged | Actually paid | vs national |
|---|---|---|---|
|
Level 1 Intraocular Procedures
APC 5491 · Hospital outpatient visit |
$11,925 | $2,229 | about average |
|
Level 3 Urology and Related Services
APC 5373 · Hospital outpatient visit |
$11,205 | $1,948 | -13% |
|
Level 3 Musculoskeletal Procedures
APC 5113 · Hospital outpatient visit |
$16,633 | $3,096 | -18% |
|
Level 4 Musculoskeletal Procedures
APC 5114 · Hospital outpatient visit |
$30,800 | $6,843 | -23% |
|
Level 3 Excision/ Biopsy/ Incision and Drainage
APC 5073 · Hospital outpatient visit |
$12,898 | $2,718 | -27% |
|
Level 5 Urology and Related Services
APC 5375 · Hospital outpatient visit |
$19,094 | $4,950 | -30% |
|
Level 5 Musculoskeletal Procedures
APC 5115 · Hospital outpatient visit |
$42,988 | $12,571 | -31% |
|
Level 3 Vascular Procedures
APC 5183 · Hospital outpatient visit |
$12,587 | $3,049 | -34% |
Where it charges least relative to everyone else
| Procedure | Charged | Actually paid | vs national |
|---|---|---|---|
|
Respiratory Failure
MS-DRG 189 · Inpatient stay |
$16,682 | $9,447 | -66% |
|
Sepsis (without major complications)
MS-DRG 872 · Inpatient stay |
$15,851 | $8,022 | -60% |
|
Sepsis (severe)
MS-DRG 871 · Inpatient stay |
$28,785 | $15,298 | -56% |
|
Pneumonia (severe)
MS-DRG 193 · Inpatient stay |
$21,209 | $10,246 | -54% |
|
Respiratory Infection (severe)
MS-DRG 177 · Inpatient stay |
$25,982 | $12,925 | -53% |
|
Heart Failure (severe)
MS-DRG 291 · Inpatient stay |
$21,708 | $10,269 | -50% |
|
Level 1 Endovascular Procedures
APC 5191 · Hospital outpatient visit |
$13,145 | $3,122 | -48% |
|
Comprehensive Observation Services
APC 8011 · Hospital outpatient visit |
$10,410 | $2,596 | -46% |
What this page cannot tell you
- It is not your bill. These are averages across Medicare patients. What you pay depends on your insurance, your plan's negotiated rate and your own case.
- It is not a quality rating. A hospital with a high markup may be excellent, and one with a low markup may not be. We checked: across every U.S. hospital, markup and the CMS quality star rating barely move together.
- A charge is not a cost. Hospitals do not collect their list charges from insured patients. The number matters because it is the opening figure on an uninsured or out-of-network bill.
- Ask for the real number. Every U.S. hospital must publish a machine-readable price file and give you a written good-faith estimate on request.