How many shoppable procedure prices are published for UPMC Somerset?

UPMC Somerset in Somerset, PA currently has 111 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do UPMC Somerset's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, UPMC Somerset's median negotiated commercial rate is 0.9× the regionally adjusted fair BaseRate benchmark.

What is UPMC Somerset's CMS Care Compare overall star rating?

CMS Care Compare assigns UPMC Somerset an overall hospital quality rating of 4 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Voluntary non-profit - Private 56 Beds · rural Updated: 3/6/2026

UPMC Somerset

225 South Center Avenue, Somerset, PA 15501 · 111 Priced Procedures · 68% Patient Recommendation

CMS Overall Rating 4 / 5 Stars

Good Deal · Below Fair Market

0.92×vs. Fair Market Price

Typical commercial prices here are 8% below the fair benchmark (0.92×) after accounting for local nurse/doctor wages and patient complexity.

83/100 · Corroborated

83/100Self-Pay Cash Beats Insurance 41% of the Time

File Completeness56

Price Logic92

Peer Alignment79

Clean Billing91

Real Cash Discount100

Regional Value Leader

4-Star CMS clinical quality rating paired with 0.92× fair market pricing.

Behavioral Pricing FingerprintLow Shoppable & Low Captive Rates

Uniform Value Leader · Low-Cost Across Departments

UPMC Somerset maintains low, disciplined commercial pricing across both routine shoppable procedures (0.9× Medicare, p50 0.90× Fair BaseRate) and emergency/ancillary services (1.2× Medicare, p75 1.02× Fair BaseRate). Both insured and self-pay patients benefit from below-benchmark rates across departments.

#40 of 134 in PA · 29th State Percentile#803 of 3,385 in U.S. · 23rd National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Elective shoppable care is priced 8% below peer Fair BaseRate (0.92×)
Self-pay cash beats commercial insurance on 41% of shoppable procedures (99/100 Cash Honesty)
4-Star CMS clinical rating with 68% patient recommendation (69/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (36.4% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Even at low-cost facilities (0.92× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
Captive ER (1.3×) & laboratory (1.5×) services average 1.33× higher multiples than routine shoppable care (0.9×)
Specialty infusion drugs (J-codes) average 1.1× Medicare — verify per-unit billing on itemized statements
Consolidated metro market (HHI 5,396) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))

Front-Door ShoppableElective / Imaging

0.9× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER1.33× Divergence

1.2× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+13% Upper Tail

Q25 0.79× · Q50 0.90× · Q75 1.02×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.

Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×

Front-Door Shoppable CareFront-Door Shoppable

0.9× MedicareGood

Outpatient Surgery & ORBack-Door Captive

0.6× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

1.2× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

1.3× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

1.5× MedicareGood

Specialty & Infusion Drugs (J-Codes)Back-Door Captive

1.1× MedicareGood

Self-Pay Cash Honesty & 501(r)Integrity & Outcomes

41% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

4 CMS · 69/100Fair

Procedure Prices at UPMC Somerset

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 111 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Spinal fusion, single level (inpatient stay) MS-DRG Code: `451`	—	$24,220	$30,775	0.8×
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$15,146	$19,087	0.8×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$15,040	$19,432	0.8×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$14,274	$17,936	0.8×
Total hip replacement CPT Code: `27130`	—	$12,267	$13,413	0.9×
Total knee replacement CPT Code: `27447`	—	$12,267	$13,523	0.9×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$6,794	$8,223	0.8×
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$3,093	$3,372	0.9×
Bunion correction surgery CPT Code: `28296`	—	$3,093	$3,446	0.9×
Gallbladder removal (laparoscopic) CPT Code: `47562`	$2,270	$2,270	$6,109	0.4×
Cataract surgery with lens implant CPT Code: `66984`	—	$2,174	$2,540	unverified
C-section delivery (full package) CPT Code: `59510`	$10,034	$2,054	$2,975	0.7×
Inguinal hernia repair CPT Code: `49505`	$1,697	$1,697	$3,629	unverified
Colonoscopy with biopsy CPT Code: `45380`	—	$1,124	$1,256	unverified
Breast lump removal CPT Code: `19120`	$1,078	$1,078	$3,875	0.3×
Upper endoscopy with biopsy CPT Code: `43239`	$2,051	$894	$987	0.9×
Colonoscopy (diagnostic) CPT Code: `45378`	$887	$869	$981	0.9×
Injection procedure for pain management HCPCS Code: `G0260`	$2,647	$667	$855	0.8×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$1,505	$523	$583	0.9×
MRI, knee or other leg joint CPT Code: `73721`	$1,656	$461	$369	unverified
Blood transfusion CPT Code: `36430`	$1,476	$413	$498	0.8×
MRI, brain (with and without contrast) CPT Code: `70553`	$2,855	$389	$511	0.8×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$1,662	$347	$448	0.8×
MRI, brain (no contrast) CPT Code: `70551`	$959	$371	$343	unverified
Speech therapy (language evaluation) CPT Code: `92507`	$298	$298	$86	3.5×
MRI, lower back (no contrast) CPT Code: `72148`	$1,656	$294	$338	0.9×
Rabies immune globulin HCPCS Code: `90375`	$408	$280	$322	0.9×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$450	$230	$272	0.8×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$1,822	$234	$303	0.8×
Breathing treatment (nebulizer) CPT Code: `94640`	$418	$194	$201	1.0×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$310	$158	$148	1.1×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$876	$152	$168	0.9×
CT scan, chest (no contrast) CPT Code: `71250`	$575	$150	$167	0.9×
CT scan, head (with contrast) CPT Code: `70460`	$1,295	$173	$242	0.7×
CT scan, head (with and without contrast) CPT Code: `70470`	$1,298	$183	$258	0.7×
Screening mammogram (both breasts) CPT Code: `77067`	$257	$127	$123	1.0×
CT scan, sinuses CPT Code: `70486`	$797	$149	$166	0.9×
CT scan, neck (cervical spine) CPT Code: `72125`	$797	$150	$169	0.9×
Hepatitis B immune globulin HCPCS Code: `90371`	$106	$134	$151	0.9×
Psychotherapy session (60 minutes) CPT Code: `90837`	$302	$153	$181	0.8×
Psychiatric evaluation (first visit) CPT Code: `90791`	$514	$156	$185	0.8×
CT scan, head (no contrast) CPT Code: `70450`	$951	$134	$160	0.8×
Ultrasound, abdomen (complete) CPT Code: `76700`	$298	$109	$134	0.8×
CT scan, pelvis CPT Code: `72192`	$551	$129	$163	0.8×
X-ray, lower back CPT Code: `72110`	$210	$101	$112	0.9×
Ultrasound, abdomen (limited) CPT Code: `76705`	$298	$101	$126	0.8×
Ultrasound, pelvis CPT Code: `76856`	$337	$103	$130	0.8×
Ultrasound, thyroid and neck CPT Code: `76536`	$382	$101	$132	0.8×
Hospital observation (per hour) HCPCS Code: `G0378`	$112	$112	$86	unverified
X-ray, chest (single view) CPT Code: `71045`	$153	$84	$92	unverified
X-ray, chest (two views) CPT Code: `71046`	$153	$84	$93	unverified
X-ray, neck (cervical spine) CPT Code: `72040`	$188	$84	$93	unverified
X-ray, pelvis CPT Code: `72170`	$263	$100	$110	unverified
Typhoid vaccine HCPCS Code: `90675`	$254	$314	$347	0.9×
Drug screening test HCPCS Code: `G0480`	$137	$114	$116	1.0×
Diagnostic procedure preparation HCPCS Code: `G0279`	$65	$49	$35	1.4×
Occupational therapy (self-care training) CPT Code: `97535`	$97	$42	$38	1.1×
Orthotic fitting and training CPT Code: `97760`	$61	$52	$51	1.0×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$87	$20	$20	1.0×
Pneumonia vaccine injection HCPCS Code: `G0009`	$47	$43	$49	0.9×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$197	$56	$64	0.9×
New patient office visit (30-44 min) CPT Code: `99203`	$160	$75	$110	0.7×
Office visit, established patient (30-39 min) CPT Code: `99214`	$93	$76	$123	0.6×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$54	$54	$111	0.5×
Blood test, clotting time (PTT) CPT Code: `85730`	$33	$9	$6	1.5×
Blood test, thyroid (TSH) CPT Code: `84443`	$78	$26	$18	1.4×
Blood test, PSA (prostate screen) CPT Code: `84153`	$113	$27	$19	1.4×
Office visit, established patient (20-29 min) CPT Code: `99213`	$132	$49	$87	0.6×
X-ray, hip CPT Code: `73502`	$188	$40	$93	0.4×
Blood test, calcium CPT Code: `82310`	$26	$8	$5	1.6×
Blood test, creatinine (kidney) CPT Code: `82565`	$26	$7	$5	1.4×
Blood test, potassium CPT Code: `84132`	$22	$7	$5	1.4×
Blood test, sodium CPT Code: `84295`	$23	$7	$5	1.4×
Hepatitis C antibody test CPT Code: `86803`	$108	$21	$15	1.4×
Colorectal cancer screening HCPCS Code: `G0010`	$99	$44	$49	0.9×
Culture, blood CPT Code: `87040`	$57	$15	$11	1.4×
Blood test, basic metabolic panel CPT Code: `80048`	$51	$11	$9	1.2×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$83	$16	$14	1.1×
Blood test, liver function panel CPT Code: `80076`	$50	$10	$9	1.1×
Hepatitis B vaccine HCPCS Code: `90744`	$33	$32	$37	0.9×
X-ray, shoulder CPT Code: `73030`	$188	$35	$92	0.4×
X-ray, ankle CPT Code: `73610`	$188	$34	$93	0.4×
Blood test, glucose (blood sugar) CPT Code: `82947`	$21	$5	$4	1.3×
Blood test, magnesium CPT Code: `83735`	$37	$8	$7	1.1×
Colorectal cancer screening (alternative) HCPCS Code: `G0145`	$150	$28	$27	1.0×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$22	$3	$3	1.0×
Blood test, ferritin (iron stores) CPT Code: `82728`	$64	$14	$14	1.0×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$48	$10	$10	1.0×
Blood test, lipase CPT Code: `83690`	$38	$7	$7	1.0×
Blood test, complete blood count (CBC) CPT Code: `85025`	$42	$8	$8	1.0×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$22	$5	$5	1.0×
Culture, bacterial CPT Code: `87070`	$47	$9	$9	1.0×
Electrocardiogram (ECG/EKG) CPT Code: `93000`	$147	$25	$25	1.0×
Blood test, vitamin B12 CPT Code: `82607`	$71	$15	$16	0.9×
Blood test, amylase CPT Code: `82150`	$35	$6	$7	0.9×
Physical therapy (manual therapy) CPT Code: `97140`	$55	$28	$34	0.8×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$78	$24	$38	0.6×
Physical therapy (gait training) CPT Code: `97116`	$44	$18	$33	0.5×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$59	$18	$35	0.5×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$54	$27	$56	0.5×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$65	$19	$40	0.5×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$32	$13	$39	0.3×
X-ray, foot CPT Code: `73630`	$188	$26	$92	0.3×
X-ray, hand CPT Code: `73130`	$188	$26	$93	0.3×
Blood test, vitamin D CPT Code: `82306`	$140	$45	$31	unverified
Flu vaccine injection HCPCS Code: `G0008`	$13	$13	$48	0.3×
Blood antibody screen CPT Code: `86850`	$65	$10	$46	0.2×
Psychological testing evaluation CPT Code: `96136`	$55	$23	$128	0.2×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$56	$13	$11	unverified
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$21	$6	$4	unverified
Blood test, hemoglobin CPT Code: `85018`	$13	$4	$3	unverified

Showing top 25 high-impact procedures of 111 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.4%

Audit a Bill or Quote at UPMC Somerset (Zero PHI Required)

CMS CCN: 390039

CPT 451

Select Procedure to Audit:

Fair BaseRate™ $30,775

Medicare Rate $23,504

Self-Pay Cash Request Quote

Insurer Median $24,220

1. Amount on Your Bill or Quote ($) Pre-filled with UPMC Somerset’s charged/list benchmark

2. Household Annual Income ($) Screened against 2026 HHS Federal Poverty Guidelines

3. Household Size (1–8) 2026 FPL: $15,650 + $5,500 per additional person

Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $21,159 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $21,159

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.4% of gross = $21,159).

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask UPMC Somerset's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$27,353 Above Fair BaseRate

Negotiate Toward $30,775 Fair BaseRate ($23,504 Medicare)

Your bill ($58,128) is $27,353 above the denoised Fair BaseRate ($30,775) and 2.5× the $23,504 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.

IRS Form 990 Schedule H & 26 U.S.C. § 501(r) 501(c)(3) Nonprofit Hospital

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

Free Care Eligibility BenchmarkUp to 200% FPL100% charity write-off income threshold

Discounted Care EligibilityUp to 400% FPLSliding-scale & AGB billing cap tier

Charity Care Share of ExpensesSee Schedule HNet community financial assistance reported

26 U.S.C. § 501(r)(5) AGB Benchmark Method: lookback_commercial_median

Hospital-Specific CMS HCRIS Benchmark (36.4% of gross charges)

Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑

CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall4/5 Stars (4/5)

Safety Composite69/100

Would Recommend68%

Rated 9 or 10 (HCAHPS)73%

Median ER Wait217 min

Left ER Before Seen2%

30-Day Mortality vs U.S.same

Unplanned Readmissionsame

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)

C. diff Hospital-Onset Infectionsame

CMS Price Transparency Administrative Enforcement Log

Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at UPMC Somerset. Prior administrative notices do not necessarily reflect current compliance status.

2025-03-20·administrative_or_closure
Closure Notice
Recorded
2025-02-13·warning_notice
Warning Notice
Recorded

Source: CMS Hospital Care Compare (361 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Higher-Quality, Above-Median Price Tier Pareto Frontier (Price + Quality)

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for UPMC Somerset.

Price Index: 2.06× regional baseline

Quality: 67/100 CMS composite

Median Household Income$59,378U.S. Census ACS

Local Uninsured Share5.8%Regional ACS estimate

200% FPL (1 Person)$31,920Common free-care ceiling

400% FPL (Family of 4)$128,600Common AGB cap ceiling

45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 83/100 · Corroborated CMS CCN 390039

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (CMS_45_CFR_180_FILING.json) Verify on CMS Medicare.gov (CCN 390039) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage3/6/2026

Validated Rate Rows3,034 (CMS v3.0.0)

File Integrity DigestVerified · CCN 390039

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy