CMS Price Transparency Data

Blood transfusion

Facility: St James Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $35
Cash Discount Price: $831
vs. Medicare Baseline: 0.08x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at St James Hospital is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $831. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.08x the Medicare baseline. Located in 411 Canisteo Street, Hornell, NY.

Cash / Self-Pay

$831

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $831 (184%)

Insurance Median: $35 (8%)

Cash: $831 (184% of Medicare)

Ins. Median: $35 (8% 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	$8 - $1,319	2%
Fidelis 5155	$8 - $36	2%
Medicaid / KanCare	$8 - $36	2%
Molina Healthcare 1723	$8 - $18	2%
UnitedHealthcare	$8 - $590	2%
Medicare (plans)	$29 - $649	6%
Mvp 2900	$29 - $1,280	6%
Aetna	$34 - $590	8%
Excellus 2201	$34 - $40	8%
Cigna	$41 - $1,326	9%
Capital District Physicians Health Plan (Cdphp) 5149	$95	21%
Humana	$590	131%
Empire Plan 5179	$1,244	276%

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 $831.
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 James 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.