CMS Price Transparency Data

Blood transfusion

Facility: Promedica Monroe Regional Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $446
Cash Discount Price: $713
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Promedica Monroe Regional Hospital is $446. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $713. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.99x the Medicare baseline. Located in 718 N Macomb St, Monroe, MI.

Cash / Self-Pay

$713

Average discount available for prompt cash payment at this facility.

Insurance Median

$446

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: $713 (158%)

Insurance Median: $446 (99%)

Cash: $713 (158% of Medicare)

Ins. Median: $446 (99% 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
Paramount Healthcare Inc	$42 - $834	9%
Aetna	$43 - $772	10%
Blue Cross Blue Shield	$43 - $616	10%
Health Alliance Plan	$43 - $900	10%
Priority Health	$43 - $603	10%
Humana	$44 - $451	10%
Meridian	$242	54%
Molina Healthcare Of Michigan	$261	58%
UnitedHealthcare	$266 - $891	59%
Amerihealth	$315	70%
Veterans Affairs	$445	99%
Frontpath	$636	141%
Encore Health Network	$768	170%
Health Ohio Network, Llc	$768	170%
Cofinity	$782	173%
Multiplan	$987	219%

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 $713.
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 Promedica Monroe Regional 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.