CMS Price Transparency Data

Blood transfusion

Facility: Forbes Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $64
Cash Discount Price: $1,228
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Forbes Hospital is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,228. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.14x the Medicare baseline. Located in 2570 Haymaker Road, Monroeville, PA.

Cash / Self-Pay

$1,228

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

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: $1,228 (272%)

Insurance Median: $64 (14%)

Cash: $1,228 (272% of Medicare)

Ins. Median: $64 (14% 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
Amerihealth	$29 - $1,280	6%
Aetna	$33 - $1,199	7%
Univera	$34 - $53	8%
Pennsylvania Health And Wellness	$37 - $1,164	8%
Highmark Wholecare	$38 - $1,071	8%
Geisinger	$40 - $1,242	9%
UnitedHealthcare	$40 - $1,329	9%
Highmark	$47 - $822	10%
Cigna	$65 - $1,228	14%
University Of Pittsburgh Medical Center	$306 - $8,536	68%
American Health Plans	$421	93%
Life Pittsburgh	$421	93%
Martin'S Point	$421	93%
Medicare (plans)	$433	96%
Humana	$446	99%
Molina	$458	102%
Medical Mutual	$1,228	272%

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 $1,228.
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 Forbes 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.