CMS Price Transparency Data

Blood transfusion

Facility: Boston Children's Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,921
Cash Discount Price: $2,599
vs. Medicare Baseline: 4.26x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Boston Children's Hospital is $1,921. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,599. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 4.26x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$2,599

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,921

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: $2,599 (577%)

Insurance Median: $1,921 (426%)

Cash: $2,599 (577% of Medicare)

Ins. Median: $1,921 (426% 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 426% of the Medicare baseline (a markup of 326%). 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
Blue Cross Blue Shield	$924 - $1,716	205%
Cdphp	$1,274 - $2,209	283%
Harvard Pilgrim	$1,321 - $1,756	293%
United	$1,554 - $2,171	345%
Aetna	$1,559 - $2,179	346%
Mgb/Allways	$1,580 - $1,921	351%
Tufts Public Plan	$1,597 - $1,600	354%
United Ri Nj Ny	$1,637	363%
Ambetter / Centene	$1,643	365%
Carelon Strategies/Bhs	$1,689	375%
UnitedHealthcare	$1,689 - $2,209	375%
Carelon/Beacon	$1,949	432%
Fallon	$1,983 - $2,004	440%
Health New England	$2,100	466%
Cigna	$2,209 - $2,345	490%
Ets/Lifetrac	$2,209	490%
Interlink Transplant	$2,209	490%
Community Health Options	$2,339	519%
Humana	$2,339	519%
Coventry/Hcvm/First Health	$2,391	530%
Multiplan/Phcs	$2,391 - $2,469	530%

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 $2,599.
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 Boston Children's 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.