CMS Price Transparency Data

Blood transfusion

Facility: Highlands Cashiers Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $673
Cash Discount Price: $1,496
vs. Medicare Baseline: 1.49x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Highlands Cashiers Hospital is $673. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,496. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.49x the Medicare baseline. Located in 190 Hospital Drive, Highlands, NC.

Cash / Self-Pay

$1,496

Average discount available for prompt cash payment at this facility.

Insurance Median

$673

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: $1,496 (332%)

Insurance Median: $673 (149%)

Cash: $1,496 (332% of Medicare)

Ins. Median: $673 (149% 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
Cigna	$361 - $840	80%
Blue Cross Blue Shield	$375 - $788	83%
United	$380 - $1,147	84%
Wellcare	$386 - $663	86%
Amerihealth	$390 - $670	87%
Partners Health Management	$393 - $676	87%
Vaya Health	$393 - $676	87%
Amerihealth Caritas	$418 - $719	93%
Aetna	$428 - $1,376	95%
Caresource	$484 - $833	107%
Oscar	$503 - $865	112%
Medcost	$516 - $1,068	114%
Magellan	$660 - $1,135	146%
Magellan Behavioral Health	$660 - $1,135	146%
Multiplan	$881 - $1,514	195%
Avalon Administrative Services	$936 - $1,608	208%
Prime Health	$969 - $1,703	215%
Apex Health	$2,550	566%
Nhc Advantage	$2,800	621%

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 $1,496.
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 Highlands Cashiers 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.