CMS Price Transparency Data

Blood transfusion

Facility: Atrium Health Cleveland

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $652
Cash Discount Price: $738
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Atrium Health Cleveland is $652. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $738. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.45x the Medicare baseline. Located in 201 E Grover St, Shelby, NC.

Cash / Self-Pay

$738

Average discount available for prompt cash payment at this facility.

Insurance Median

$652

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: $738 (164%)

Insurance Median: $652 (145%)

Cash: $738 (164% of Medicare)

Ins. Median: $652 (145% 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
Trillium	$27 - $219	6%
Alliance	$28 - $247	6%
Amerihealth Caritas	$28 - $208	6%
Carolina Complete Health	$28 - $212	6%
Healthy Blue	$28 - $212	6%
Partners	$28 - $207	6%
UnitedHealthcare	$28 - $788	6%
Vaya	$28 - $214	6%
Wellcare	$28 - $212	6%
Cigna	$38 - $1,181	8%
Humana	$39 - $419	9%
Aetna	$40 - $1,136	9%
Blue Cross Blue Shield	$459 - $604	102%
Ambetter / Centene	$471 - $536	104%
Employers Health Network	$652	145%
Physician Reach Out	$738	164%
Medcost	$824 - $978	183%
Magellan	$885	196%
Gmmi	$959	213%
Quik Trip	$959	213%
Carolina Behavioral Health	$1,063 - $1,181	236%
Healthgram	$1,181	262%
Choicecare	$1,210	268%
First Health	$1,254	278%
Lifesynch Community Choice Care	$1,254	278%
Private Health Care Systems	$1,328	295%
Beechstreet	$1,358	301%
Multiplan	$1,402	311%

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 $738.
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 Atrium Health Cleveland 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.