CMS Price Transparency Data

Blood transfusion

Facility: Hospital for Special Surgery

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $2,033
Cash Discount Price: $27,515
vs. Medicare Baseline: 4.51x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Hospital for Special Surgery is $2,033. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $27,515. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 4.51x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$27,515

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,033

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: $27,515 (6105%)

Insurance Median: $2,033 (451%)

Cash: $27,515 (6105% of Medicare)

Ins. Median: $2,033 (451% 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 451% of the Medicare baseline (a markup of 351%). 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
Blue Cross Blue Shield	$8 - $50,613	2%
UnitedHealthcare	$11 - $26,313	2%
Affinity By Molina Health Plan [1005]	$18 - $2,060	4%
Fidelis Essential [1323]	$18	4%
Aetna	$939 - $20,943	208%
Christian Brothers [1034]	$939 - $20,943	208%
Connecticare [1039]	$939 - $17,183	208%
Emblem Health [1043]	$939 - $17,183	208%
Geha [1053]	$939 - $22,931	208%
Harvard Pilgrim [1057]	$939 - $26,313	208%
Medicare (plans)	$939	208%
Meritain Health [1085]	$939 - $20,943	208%
Nippon Life [1092]	$939 - $20,943	208%
Oxford [1096]	$939 - $22,812	208%
Student Resources [1103]	$939 - $22,931	208%
Webtpa [1356]	$939 - $20,943	208%
Apwu [1016]	$1,661 - $21,217	369%
Cigna	$1,661 - $21,217	369%
Nalc [1090]	$1,661 - $21,217	369%
Qualcare [1101]	$1,661 - $21,217	369%
Wellfleet [1361]	$1,661 - $21,217	369%

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 $27,515.
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 Hospital for Special Surgery 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.