CMS Price Transparency Data

Blood transfusion

Facility: Berkshire Medical Center

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $572
Cash Discount Price: $895
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Berkshire Medical Center is $572. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $895. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.27x the Medicare baseline. Located in 725 North Street, Pittsfield, MA.

Cash / Self-Pay

$895

Average discount available for prompt cash payment at this facility.

Insurance Median

$572

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: $895 (199%)

Insurance Median: $572 (127%)

Cash: $895 (199% of Medicare)

Ins. Median: $572 (127% 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
Cdphp	$31 - $848	7%
Health New England	$31 - $688	7%
Mcd Out Of State	$31 - $515	7%
Medicaid / KanCare	$31 - $515	7%
Comm Tufts Qhpsub (Network)	$34 - $533	8%
Point32Health	$34 - $895	8%
Bmchnp	$36 - $669	8%
Fallon	$44 - $669	10%
Other Government	$44 - $566	10%
Medicare (plans)	$49 - $557	11%
Hospice	$50 - $566	11%
UnitedHealthcare	$50 - $811	11%
Blue Cross Blue Shield	$51 - $801	11%
Commcare Alliance	$51 - $669	11%
Aetna	$59 - $712	13%
Comm Hne Hmo	$75 - $650	17%
Unicare	$78 - $611	17%
Comm Hne Ppo	$80 - $691	18%
Mbhp	$515	114%
Workers Comp	$572	127%
Allways Nhp	$610	135%
Beacon	$801 - $848	178%
Cigna	$848 - $877	188%
Mvp	$848	188%
Oxford	$848	188%
First Health	$877 - $895	195%
Connecticare	$895	199%
Consolidated Health Plans	$895	199%
Other Commercial	$895	199%
Phcs	$895	199%
Self Pay	$895	199%

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 $895.
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 Berkshire 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.