CMS Price Transparency Data

Blood transfusion

Facility: Southwest General Health Center

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $689
Cash Discount Price: $1,111
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Southwest General Health Center is $689. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,111. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.53x the Medicare baseline. Located in 18697 Bagley Road, Middleburg Heights, OH.

Cash / Self-Pay

$1,111

Average discount available for prompt cash payment at this facility.

Insurance Median

$689

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: $1,111 (246%)

Insurance Median: $689 (153%)

Cash: $1,111 (246% of Medicare)

Ins. Median: $689 (153% 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
Medical Mutual	$174 - $181	39%
Medical Mutual-Ohio	$174	39%
Amerihealth Caritas	$413	92%
Blue Cross Blue Shield	$413	92%
Buckeye	$413 - $547	92%
Caresource	$413	92%
Humana	$413 - $608	92%
Molina	$413 - $547	92%
UnitedHealthcare	$413 - $842	92%
Healthsmart	$455 - $499	101%
Health Design Plus	$527 - $577	117%
Clarity Health	$569 - $624	126%
Healthspan	$569 - $624	126%
Healthsmart Preferred	$640 - $702	142%
Ohio Health Choice Plus	$689 - $755	153%
Summacare	$768 - $842	170%
Cigna	$778 - $853	173%
Coventry	$982 - $1,076	218%
First Health	$982 - $1,076	218%
Ohio Health Choice	$1,100 - $1,205	244%
Private Healthare Systems	$1,138 - $1,247	252%
Aetna	$2,301	511%

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 $1,111.
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 Southwest General Health 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.