CMS Price Transparency Data

Blood transfusion

Facility: St John's Episcopal Hospital at South Shore

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $551
Cash Discount Price: $4,488
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at St John's Episcopal Hospital at South Shore is $551. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,488. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.22x the Medicare baseline. Located in 327 Beach 19Th Street, Far Rockaway, NY.

Cash / Self-Pay

$4,488

Average discount available for prompt cash payment at this facility.

Insurance Median

$551

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: $4,488 (996%)

Insurance Median: $551 (122%)

Cash: $4,488 (996% of Medicare)

Ins. Median: $551 (122% 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
1199 National Benefit Fund	$50	11%
Healthfirst	$457 - $1,239	101%
Vns	$523 - $551	116%
Aetna	$551 - $771	122%
Blue Cross Blue Shield	$551 - $2,254	122%
Centerlight	$551	122%
Centers Plan For Healthy Living	$551	122%
Elderplan	$551	122%
Emblem Health	$551	122%
Fidelis	$551	122%
Hamaspik	$551	122%
Humana	$551	122%
Longevity	$551	122%
Lucida	$551	122%
Metroplus	$551	122%
UnitedHealthcare	$551	122%
Village Care Max	$551	122%
Wellcare	$551	122%
Magnacare	$606	134%
Molina	$606	134%

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 $4,488.
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 John's Episcopal Hospital at South Shore 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.