CMS Price Transparency Data

Blood transfusion

Facility: St Joseph's University Medical Center Inc

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $524
Cash Discount Price: $2,297
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at St Joseph's University Medical Center Inc is $524. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,297. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.16x the Medicare baseline. Located in 703 Main St, Paterson, NJ.

Cash / Self-Pay

$2,297

Average discount available for prompt cash payment at this facility.

Insurance Median

$524

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: $2,297 (510%)

Insurance Median: $524 (116%)

Cash: $2,297 (510% of Medicare)

Ins. Median: $524 (116% 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
UnitedHealthcare	$12 - $1,141	3%
Wellpoint	$14 - $524	3%
Fidelis Care of New Jersey	$41 - $550	9%
Blue Cross Blue Shield	$42 - $1,492	9%
Aetna	$55 - $1,148	12%
Ambetter / Centene	$55 - $786	12%
Amerihealth	$55 - $1,462	12%
Clover Health	$55 - $524	12%
Horizon New Jersey Total Care	$55 - $524	12%
Multiplan	$82 - $1,723	18%
Consumer Health Network	$105 - $2,067	23%
Oxford	$525 - $5,256	116%
Longevity Health Plan	$603	134%
Horizon New Jersey Health	$712	158%
Private Healthcare Systems	$1,493	331%
Magnacare	$1,608	357%
Oscar	$2,164	480%
Cigna	$2,297	510%

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 $2,297.
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 St Joseph's University Medical Center Inc 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.