CMS Price Transparency Data

Blood transfusion

Facility: Southern Ocean Medical Center

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,880
Cash Discount Price: $478
vs. Medicare Baseline: 4.17x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Southern Ocean Medical Center is $1,880. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $478. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 4.17x the Medicare baseline. Located in 1140 Rt 72 W, Manahawkin, NJ.

Cash / Self-Pay

$478

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,880

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: $478 (106%)

Insurance Median: $1,880 (417%)

Cash: $478 (106% of Medicare)

Ins. Median: $1,880 (417% 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 417% of the Medicare baseline (a markup of 317%). 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
Karna	$90	20%
Oxford	$359 - $1,720	80%
Clover	$436	97%
Aetna	$448 - $2,178	99%
Wellcare	$478	106%
Blue Cross Blue Shield	$478	106%
Vaccn	$478	106%
Seoul Medical Group	$496	110%
United Community/Americhoice	$502	111%
UnitedHealthcare	$573 - $4,793	127%
Horizon	$1,575 - $2,212	349%
Bergen Risk	$1,815	403%
Cigna	$1,936 - $2,314	430%
Multiplan - PHCS	$2,057	456%
Amerihealth	$2,102 - $2,380	466%
Brighton Health Plan	$2,178	483%
Qualcare	$2,197	487%

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 $478.
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 Southern Ocean 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.