CMS Price Transparency Data
Blood transfusion
Facility: Pennsylvania Hospital
Billing Code: 36430 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 36430
- Insurance Median: $738
- Cash Discount Price: $1,280
- vs. Medicare Baseline: 1.64x Medicare
The contracted insurance negotiated median rate for a Blood transfusion at Pennsylvania Hospital is $738. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,280. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.64x the Medicare baseline. Located in 800 Spruce Street, Philadelphia, PA.
Cash / Self-Pay
$1,280
Average discount available for prompt cash payment at this facility.
Insurance Median
$738
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: $1,280 (284%)
Insurance Median: $738 (164%)
Cash: $1,280 (284% of Medicare)
Ins. Median: $738 (164% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Gateway Health Plan | $28 - $572 | 6% |
| Medicaid / KanCare | $28 - $1,569 | 6% |
| Pa Medical Assistance | $28 | 6% |
| Keystone Mercy Health Plan | $36 | 8% |
| Upmc | $47 - $1,569 | 10% |
| Health Partners | $144 - $1,569 | 32% |
| Horizon Nj Health | $167 - $276 | 37% |
| UnitedHealthcare | $203 - $1,529 | 45% |
| Pgm - Regie De L'Assurance Maladie Quebec | $228 - $361 | 51% |
| Preferred Health Care Eliance | $257 - $408 | 57% |
| Blue Cross Blue Shield | $267 - $1,569 | 59% |
| Aetna | $275 - $1,569 | 61% |
| Cigna | $335 - $604 | 74% |
| Pgm - Kuwait Defense | $346 - $706 | 77% |
| Devon | $376 - $706 | 83% |
| Qualcare | $376 - $596 | 83% |
| Coventry | $396 - $800 | 88% |
| Pgm - Chop | $396 - $628 | 88% |
| Wissahickon Hospice | $396 - $628 | 88% |
| Healthamerica/Coventry | $446 - $769 | 99% |
| Medicare (plans) | $461 - $471 | 102% |
| Philadelphia Va Medical Center | $461 | 102% |
| Tricare | $464 | 103% |
| Ibc | $471 | 104% |
| Geisinger Health Plan | $475 - $1,463 | 105% |
| Humana | $475 - $1,255 | 105% |
| Olympus | $481 - $763 | 107% |
| Pa Health And Wellness | $485 - $761 | 108% |
| Penn Life (Living Independently For Elders) | $485 | 108% |
| First Health Global | $495 - $784 | 110% |
| Urn-Cancer Resource Services | $495 - $784 | 110% |
| Clover Health Plan | $498 | 110% |
| Keystone First | $512 | 114% |
| Us Family Health Plan | $533 | 118% |
| Health Net | $594 - $941 | 132% |
| Pgm - Royal Embassy Of Saudi Arabia | $594 - $941 | 132% |
| Pgm - Embassy Of Qatar | $644 - $1,020 | 143% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $644 - $1,020 | 143% |
| Elap | $655 | 145% |
| Pgm - Embassy Of The United Emirates/Ipc | $693 - $1,098 | 154% |
| Claims Watcher | $738 - $831 | 164% |
| Oscar Health Plan | $784 | 174% |
| Devon Health Services Inc | $792 - $1,255 | 176% |
| Health America/Ccn | $792 - $1,255 | 176% |
| Intergroup | $792 - $1,255 | 176% |
| Pgm - Kuwait Health Division | $792 - $1,255 | 176% |
| Pgm - Kuwait Oil | $792 - $1,255 | 176% |
| Preferred Care | $792 - $1,255 | 176% |
| Centivo | $831 | 184% |
| Elap Services | $858 | 190% |
| Ibc Commercial Hpn | $928 | 206% |
| Keystone Hmo Proactive | $928 | 206% |
| Highmark | $970 | 215% |
| Commercial Other | $990 - $1,569 | 220% |
| Community Behavioral Health | $990 - $1,569 | 220% |
| International Pfs | $990 - $1,569 | 220% |
| Quest Behavioral Health | $990 - $1,569 | 220% |
| United Behavioral Health | $990 - $1,569 | 220% |
| Workers Compensation | $990 - $1,569 | 220% |
| Penn Global Medicine | $1,223 | 271% |