CMS Price Transparency Data

Blood transfusion

Facility: SSM St Joseph Hospital West

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $179
Cash Discount Price: $815
vs. Medicare Baseline: 0.40x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at SSM St Joseph Hospital West is $179. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $815. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.40x the Medicare baseline. Located in 100 Medical Plaza, Lake Saint Louis, MO.

Cash / Self-Pay

$815

Average discount available for prompt cash payment at this facility.

Insurance Median

$179

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: $815 (181%)

Insurance Median: $179 (40%)

Cash: $815 (181% of Medicare)

Ins. Median: $179 (40% 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
Blue Cross Blue Shield	$35 - $449	8%
Aetna	$442 - $2,414	98%
UnitedHealthcare	$448 - $932	99%
Humana	$449	100%
Oscar	$530	118%
Cigna	$2,004	445%
Ambetter / Centene	$2,167	481%
Healthlink	$2,302 - $3,829	511%

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 $815.
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 SSM St Joseph Hospital West 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.