CMS Price Transparency Data

Blood transfusion

Facility: UPMC St Margaret

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $474
Cash Discount Price: $1,009
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at UPMC St Margaret is $474. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,009. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.05x the Medicare baseline. Located in 815 Freeport Road, Pittsburgh, PA.

Cash / Self-Pay

$1,009

Average discount available for prompt cash payment at this facility.

Insurance Median

$474

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: $1,009 (224%)

Insurance Median: $474 (105%)

Cash: $1,009 (224% of Medicare)

Ins. Median: $474 (105% 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
UnitedHealthcare	$31	7%
Upmc Health Plan	$31 - $360	7%
Highmark Wholecare (Prev Gateway)	$41 - $450	9%
Amerihealth Caritas	$43	10%
Pa Health & Wellness	$47 - $450	10%
Upmc Work Partners	$79	18%
Blue Cross Blue Shield	$131 - $1,013	29%
Aetna	$424 - $672	94%
Cigna	$471 - $672	104%
Coventry/First Health	$1,177	261%
Private Health Care Systems	$1,345	298%
Selectcare	$1,345	298%
Humana	$1,429	317%

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 $1,009.
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 St Margaret 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.