CMS Price Transparency Data

Blood transfusion

Facility: St Anthony Summit Medical Center

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,111
Cash Discount Price: $728
vs. Medicare Baseline: 2.46x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at St Anthony Summit Medical Center is $1,111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $728. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.46x the Medicare baseline. Located in 340 Peak One Drive, Frisco, CO.

Cash / Self-Pay

$728

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,111

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: $728 (162%)

Insurance Median: $1,111 (246%)

Cash: $728 (162% of Medicare)

Ins. Median: $1,111 (246% 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 246% of the Medicare baseline (a markup of 146%). 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
Aetna	$43 - $2,029	10%
Blue Cross Blue Shield	$43 - $2,866	10%
Cigna	$43 - $1,938	10%
Devoted Health	$43	10%
Humana	$43	10%
Kaiser	$43	10%
Medicare (plans)	$43	10%
UnitedHealthcare	$43 - $1,988	10%
Co Community Health Alliance	$325	72%
Colorado Access	$350	78%
Denver Health	$411 - $1,352	91%
Centura Employee Plan	$451 - $692	100%
Direct To Employer	$554 - $1,352	123%
Peak Health	$554 - $902	123%
United Colorado Doctor'S Plan	$985 - $1,542	219%
Multiplan	$1,274 - $2,074	283%

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 $728.
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 St Anthony Summit Medical Center 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.