CMS Price Transparency Data

Blood transfusion

Facility: Ellenville Regional Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $676
Cash Discount Price: $1,014
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Ellenville Regional Hospital is $676. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,014. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.50x the Medicare baseline. Located in 10 Healthy Way, Ellenville, NY.

Cash / Self-Pay

$1,014

Average discount available for prompt cash payment at this facility.

Insurance Median

$676

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: $1,014 (225%)

Insurance Median: $676 (150%)

Cash: $1,014 (225% of Medicare)

Ins. Median: $676 (150% 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
UnitedHealthcare	$203 - $1,014	45%
Emblemhealth	$460 - $1,082	102%
Cdphp	$500	111%
Blue Cross Blue Shield	$541	120%
Fidelis	$541	120%
Hamaspik Choice	$541	120%
Humana	$541	120%
Mvp Health Care Of Ny	$568 - $1,014	126%
Aetna	$622 - $946	138%
Local 1199Seiu	$622 - $946	138%
Wellcare	$744	165%
Galaxy Health	$879	195%
Oxford Health Plans	$1,014	225%

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 $1,014.
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 Ellenville Regional 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.