CMS Price Transparency Data

Blood transfusion

Facility: UPMC Northwest

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $621
Cash Discount Price: $932
vs. Medicare Baseline: 1.38x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at UPMC Northwest is $621. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $932. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.38x the Medicare baseline. Located in 100 Fairfield Drive, Seneca, PA.

Cash / Self-Pay

$932

Average discount available for prompt cash payment at this facility.

Insurance Median

$621

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: $932 (207%)

Insurance Median: $621 (138%)

Cash: $932 (207% of Medicare)

Ins. Median: $621 (138% 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 - $427	7%
UnitedHealthcare	$32 - $458	7%
Aetna	$33 - $1,009	7%
Highmark Wholecare (Prev Gateway)	$41 - $450	9%
Amerihealth Caritas	$43 - $450	10%
Pa Health & Wellness	$47 - $450	10%
Upmc Work Partners	$76	17%
Blue Cross Blue Shield	$338 - $417	75%
Cigna	$621 - $1,009	138%
Intergroup	$1,009 - $3,704	224%
Coventry/First Health	$1,087	241%
Health Coalition Partners	$1,118	248%
Private Health Care Systems	$1,242	276%
Humana	$1,320	293%

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 $932.
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 Northwest 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.