CMS Price Transparency Data

Blood test, hemoglobin

Facility: UPMC Northwest

Billing Code: 85018 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85018
Insurance Median: $16
Cash Discount Price: $24
vs. Medicare Baseline: 6.75x Medicare

The contracted insurance negotiated median rate for a Blood test, hemoglobin at UPMC Northwest is $16. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $24. Compared to the federal Medicare reimbursement reference rate of $2.37, this hospital’s rate is 6.75x the Medicare baseline. Located in 100 Fairfield Drive, Seneca, PA.

Cash / Self-Pay

$24

Average discount available for prompt cash payment at this facility.

Insurance Median

$16

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$2.37

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $2.37 (100%)

Cash / Self-Pay: $24 (1013%)

Insurance Median: $16 (675%)

Cash: $24 (1013% of Medicare)

Ins. Median: $16 (675% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $2.37 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 675% of the Medicare baseline (a markup of 575%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$2 - $26	84%
Blue Cross Blue Shield	$2 - $15	84%
Geisinger	$2	84%
UnitedHealthcare	$2 - $4	84%
Upmc Health Plan	$2 - $5	84%
Upmc Work Partners	$2	84%
Amerihealth Caritas	$3 - $5	127%
Highmark Wholecare (Prev Gateway)	$3 - $5	127%
Pa Health & Wellness	$3 - $6	127%
Cigna	$16 - $26	675%
Intergroup	$26 - $3,704	1097%
Coventry/First Health	$28	1181%
Health Coalition Partners	$29	1224%
Private Health Care Systems	$32	1350%
Humana	$34	1435%

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 $24.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85018.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC Northwest is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 85018.
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.