CMS Price Transparency Data

Blood transfusion

Facility: Pender Memorial Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $985
Cash Discount Price: $789
vs. Medicare Baseline: 2.19x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Pender Memorial Hospital is $985. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $789. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.19x the Medicare baseline. Located in 507 E Fremont St, Burgaw, NC.

Cash / Self-Pay

$789

Average discount available for prompt cash payment at this facility.

Insurance Median

$985

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: $789 (175%)

Insurance Median: $985 (219%)

Cash: $789 (175% of Medicare)

Ins. Median: $985 (219% 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 219% of the Medicare baseline (a markup of 119%). 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
Humana	$358 - $1,944	79%
Blue Cross Blue Shield	$377 - $1,628	84%
Pace Of The Southern Piedmont	$377 - $610	84%
New Hanover Health	$384 - $623	85%
Aetna	$386 - $1,922	86%
Cigna	$388 - $997	86%
Carolina Complete	$392 - $635	87%
Nc Department Of Public Safety	$392 - $1,221	87%
Amerihealth	$400 - $648	89%
Wellcare	$400 - $648	89%
Ambetter / Centene	$527 - $855	117%
Liberty Health	$535 - $867	119%
Caresource North Carolina	$558 - $904	124%
Plotkin Health	$837 - $1,357	186%
UnitedHealthcare	$1,018 - $1,651	226%
Medcost	$1,050 - $1,897	233%
Employers Choice Network	$1,353 - $2,193	300%
Three Rivers Provider Network	$1,353 - $2,193	300%

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 $789.
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 Pender Memorial 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.