CMS Price Transparency Data

Blood transfusion

Facility: Medstar Health Physical Therapy

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $534
Cash Discount Price: $534
vs. Medicare Baseline: 1.18x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Medstar Health Physical Therapy is $534. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $534. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.18x the Medicare baseline. Located in 102 Irving St Nw, Washington, DC.

Cash / Self-Pay

$534

Average discount available for prompt cash payment at this facility.

Insurance Median

$534

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: $534 (118%)

Insurance Median: $534 (118%)

Cash: $534 (118% of Medicare)

Ins. Median: $534 (118% 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
Carefirst Blue Choice Inc	$402 - $525	89%
Carefirst Advantage Inc	$462	103%
Tricare	$470	104%
UnitedHealthcare	$470 - $657	104%
Aetna	$476 - $575	106%
Health Care Service Corporation	$485	108%
Humana	$485	108%
Kaiser Permanente	$485 - $823	108%
Jhhc	$534	118%
Pfc	$534	118%
Medstar Family Choice Inc	$583	129%
Kaiser	$642	142%
Cigna	$698	155%
First Health	$698	155%
Private Healthcare Systems (Phcs)	$698	155%

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 $534.
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 Medstar Health Physical Therapy 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.