CMS Price Transparency Data

Blood transfusion

Facility: Southcoast Hospitals Group

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $575
Cash Discount Price: $840
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Southcoast Hospitals Group is $575. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $840. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.28x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$840

Average discount available for prompt cash payment at this facility.

Insurance Median

$575

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: $840 (186%)

Insurance Median: $575 (128%)

Cash: $840 (186% of Medicare)

Ins. Median: $575 (128% 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
UnitedHealthcare	$179 - $545	40%
Wellsense Health Plan Clarity Connectorcare & Meta	$359	80%
Tufts Health Public Plans [1010213]	$412 - $634	91%
Medicare (plans)	$414 - $623	92%
Aetna	$519 - $1,278	115%
Blue Cross Blue Shield	$519 - $639	115%
Evercare [1010304]	$519	115%
Tufts Senior Care Options [1010315]	$519	115%
Wellsense Health Plan Senior Care Options [1020208	$524	116%
Commonwealth Care Alliance [1080501]	$535 - $540	119%
Wellsense Health Plan [1010202]	$551	122%
Eternal Health [1010322]	$571	127%
Tufts [1010701]	$702	156%
Fallon [1000114]	$727	161%
Mass General Brigham Health Plan Commercial [10122	$947	210%
Mass General Brigham Health Plan Connectorcare [10	$947	210%
Group Insurance Service Center [1013001]	$1,008	224%
Innovative Health Plan [1025001]	$1,008	224%
Priority Health [1015001]	$1,008	224%
PHCS [1000125]	$1,092	242%
Wellpoint [1000102]	$1,092	242%
Cigna	$1,105	245%
Harvard Pilgrim [1010602]	$1,130 - $1,389	251%
First Health [1000130]	$1,278	284%

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 $840.
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 Southcoast Hospitals Group 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.