CMS Price Transparency Data

Blood transfusion

Facility: UPMC Kane

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $488
Cash Discount Price: $791
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at UPMC Kane is $488. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $791. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.08x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$791

Average discount available for prompt cash payment at this facility.

Insurance Median

$488

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: $791 (175%)

Insurance Median: $488 (108%)

Cash: $791 (175% of Medicare)

Ins. Median: $488 (108% 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
Aetna	$31 - $507	7%
UPMC Health Plan	$31 - $575	7%
UnitedHealthcare	$32 - $536	7%
Geisinger	$39	9%
Highmark Wholecare (Prev Gateway)	$41 - $502	9%
Amerihealth Caritas	$43 - $527	10%
PA Health & Wellness	$47	10%
UPMC Work Partners	$85	19%
Focus Healthcare	$94 - $1,252	21%
Blue Cross Blue Shield	$160 - $488	35%
Cigna	$923 - $29,671	205%
Horizon Health Plan	$923	205%
Multiplan	$988	219%
Intergroup	$1,054	234%
Health Coalition Partners	$1,054	234%

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 $791.
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 Kane 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.