CMS Price Transparency Data

Blood transfusion

Facility: UPMC Wellsboro

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $986
Cash Discount Price: $1,821
vs. Medicare Baseline: 2.19x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at UPMC Wellsboro is $986. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,821. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.19x the Medicare baseline. Located in 32-36 Central Avenue, Wellsboro, PA.

Cash / Self-Pay

$1,821

Average discount available for prompt cash payment at this facility.

Insurance Median

$986

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: $1,821 (404%)

Insurance Median: $986 (219%)

Cash: $1,821 (404% of Medicare)

Ins. Median: $986 (219% 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 219% of the Medicare baseline (a markup of 119%). 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
Amerihealth Caritas	$31	7%
Geisinger	$31 - $2,033	7%
Highmark Wholecare (Prev Gateway)	$31 - $607	7%
Upmc Health Plan	$31 - $1,323	7%
Health Partners Plans (Jefferson Health Plan)	$42	9%
Pa Health & Wellness	$47 - $656	10%
Upmc Work Partners	$85	19%
Aetna	$197 - $2,619	44%
Blue Cross Blue Shield	$219 - $1,535	49%
Cigna	$230 - $637	51%
UnitedHealthcare	$235 - $2,580	52%
Wirerope Works	$609 - $1,687	135%
Multiplan	$855 - $2,883	190%
America'S Choice	$986 - $2,732	219%
Intergroup	$986 - $2,732	219%

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 $1,821.
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 Wellsboro 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.