CMS Price Transparency Data

Blood transfusion

Facility: Central Florida Lake Monroe Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $372
Cash Discount Price: $814
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Central Florida Lake Monroe Hospital is $372. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $814. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.83x the Medicare baseline. Located in 1401 W Seminole Blvd, Sanford, FL.

Cash / Self-Pay

$814

Average discount available for prompt cash payment at this facility.

Insurance Median

$372

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: $814 (181%)

Insurance Median: $372 (83%)

Cash: $814 (181% of Medicare)

Ins. Median: $372 (83% 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
Freedom Health	$54 - $1,950	12%
Optimum	$54 - $1,950	12%
Simply	$114 - $2,250	25%
Oscar	$119 - $1,997	26%
Simply Healthcare	$124 - $1,735	28%
Cigna	$129 - $7,321	29%
Aetna	$147 - $425	33%
Humana	$149 - $283	33%
Avmed	$178 - $708	39%
Sunshine State Health Plan	$190 - $361	42%
Molina Healthcare	$238 - $3,950	53%
United	$248 - $2,264	55%
Florida Health Care Plan	$280 - $534	62%
Plotkin Health	$372 - $708	83%
Prime Health Sheriff	$372 - $708	83%
Corvel Corporation	$443 - $2,538	98%
Prime Health	$453 - $2,591	101%
Careworks (Rockport Community)	$467 - $2,671	104%
Multiplan	$557 - $1,204	124%
Three Rivers Provider Network	$557 - $1,062	124%
Ppo Next	$632 - $1,204	140%
Novanet	$669 - $1,275	148%
Truli For Health	$1,660	368%
Blue Cross Blue Shield	$1,759 - $5,156	390%
Evolutions	$4,121	914%
Ultimate Health Plan	$12,500	2773%

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 $814.
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 Central Florida Lake Monroe Hospital 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.