CMS Price Transparency Data

Blood transfusion

Facility: UPMC Somerset

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $438
Cash Discount Price: $1,476
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at UPMC Somerset is $438. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,476. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.97x the Medicare baseline. Located in 225 South Center Avenue, Somerset, PA.

Cash / Self-Pay

$1,476

Average discount available for prompt cash payment at this facility.

Insurance Median

$438

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$450.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $450.73 (100%)

Cash / Self-Pay: $1,476 (327%)

Insurance Median: $438 (97%)

Cash: $1,476 (327% of Medicare)

Ins. Median: $438 (97% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $450.73 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Upmc Health Plan	$31 - $425	7%
Amerihealth Caritas	$32 - $417	7%
Highmark Wholecare (Prev Gateway)	$36 - $450	8%
Geisinger	$39 - $969	9%
Upmc Work Partners	$85	19%
Blue Cross Blue Shield	$129 - $782	29%
UnitedHealthcare	$417 - $1,060	93%
Aetna	$984	218%
Multiplan	$1,230 - $1,599	273%
Galaxy Health Plan	$1,599	355%
Humana	$1,845	409%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,476.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 36430.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC Somerset is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 36430.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.