CMS Price Transparency Data

Blood transfusion

Facility: Monmouth Medical Center

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,893
Cash Discount Price: $5,419
vs. Medicare Baseline: 4.20x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Monmouth Medical Center is $1,893. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,419. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 4.20x the Medicare baseline. Located in 300 Second Avenue, Long Branch, NJ.

Cash / Self-Pay

$5,419

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,893

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: $5,419 (1202%)

Insurance Median: $1,893 (420%)

Cash: $5,419 (1202% of Medicare)

Ins. Median: $1,893 (420% 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 420% of the Medicare baseline (a markup of 320%). 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
Fidelis Care	$23 - $484	5%
UnitedHealthcare	$23 - $3,236	5%
Blue Cross Blue Shield	$30 - $3,047	7%
Aetna	$484 - $4,294	107%
Clover Health	$484	107%
Humana	$484	107%
Wellpoint	$484 - $3,266	107%
Emblem Health	$847	188%
Wellcare	$963	214%
First Health	$1,891	420%
Cigna	$1,893 - $2,533	420%
Amerihealth	$2,352	522%
Qualcare Inc	$2,699	599%

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 $5,419.
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 Monmouth Medical Center 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.