CMS Price Transparency Data

Blood transfusion

Facility: Wellspan Ephrata Community Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,380
Cash Discount Price: $1,714
vs. Medicare Baseline: 3.06x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Wellspan Ephrata Community Hospital is $1,380. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,714. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 3.06x the Medicare baseline. Located in 169 Martin Avenue, Ephrata, PA.

Cash / Self-Pay

$1,714

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,380

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: $1,714 (380%)

Insurance Median: $1,380 (306%)

Cash: $1,714 (380% of Medicare)

Ins. Median: $1,380 (306% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 306% of the Medicare baseline (a markup of 206%). 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
Medicaid / KanCare	$35 - $739	8%
Aetna	$95 - $1,659	21%
Medicare (plans)	$377 - $456	84%
Highmark	$656 - $1,936	146%
Blue_Cross	$966 - $1,380	214%
Cigna	$1,305 - $1,368	290%
Wellspan_Capital_Blue_Cross	$1,372	304%
Geisinger	$1,393	309%
Independence_Blue_Cross	$1,393	309%
Tower Health	$1,393 - $1,468	309%
Upmc	$1,393 - $1,714	309%
Phc	$1,500 - $1,522	333%
First_Health_Network	$1,824	405%
United_Healthcare	$2,021	448%

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 $1,714.
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 Wellspan Ephrata Community Hospital 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.