CMS Price Transparency Data

Blood transfusion

Facility: Blue Ridge Regional Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $400
Cash Discount Price: $971
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Blue Ridge Regional Hospital is $400. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $971. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.89x the Medicare baseline. Located in 125 Hospital Drive, Spruce Pine, NC.

Cash / Self-Pay

$971

Average discount available for prompt cash payment at this facility.

Insurance Median

$400

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: $971 (215%)

Insurance Median: $400 (89%)

Cash: $971 (215% of Medicare)

Ins. Median: $400 (89% 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	$108 - $541	24%
United	$115 - $618	26%
Wellcare	$117 - $226	26%
Amerihealth	$118 - $228	26%
Partners Health Management	$119 - $230	26%
Vaya Health	$119 - $230	26%
Aetna	$135 - $945	30%
Cigna	$230 - $535	51%
Amerihealth Caritas	$251 - $484	56%
Caresource	$298 - $575	66%
Oscar	$308 - $595	68%
Medcost	$316 - $677	70%
Magellan	$406 - $784	90%
Magellan Behavioral Health	$406 - $784	90%
Multiplan	$542 - $1,046	120%
Avalon Administrative Services	$576 - $1,111	128%
Prime Health	$596 - $1,176	132%
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 $971.
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 Blue Ridge 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.