CMS Price Transparency Data

Blood transfusion

Facility: Orthocolorado Hosp at St Anthony Med Campus

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $989
Cash Discount Price: $1,096
vs. Medicare Baseline: 2.19x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Orthocolorado Hosp at St Anthony Med Campus is $989. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,096. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.19x the Medicare baseline. Located in 11650 W 2Nd Pl, Lakewood, CO.

Cash / Self-Pay

$1,096

Average discount available for prompt cash payment at this facility.

Insurance Median

$989

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: $1,096 (243%)

Insurance Median: $989 (219%)

Cash: $1,096 (243% of Medicare)

Ins. Median: $989 (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
UnitedHealthcare	$42 - $941	9%
Aetna	$43 - $1,938	10%
Blue Cross Blue Shield	$43 - $2,866	10%
Cigna	$43 - $2,484	10%
Devoted Health	$43	10%
Humana	$43	10%
Innovage	$43	10%
Kaiser	$43 - $825	10%
Medicare (plans)	$43	10%
Centura Employee Plan	$497 - $1,498	110%
United Colorado Doctor'S Plan	$585 - $1,124	130%
Denver Health	$586 - $707	130%
Direct To Employer	$671 - $2,484	149%
Peak Health	$969 - $1,408	215%
Multiplan	$1,491 - $2,547	331%

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 $1,096.
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 Orthocolorado Hosp at St Anthony Med Campus 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.