CMS Price Transparency Data

Blood transfusion

Facility: Children's Hospital of Philadelphia

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,729
Cash Discount Price: $4,350
vs. Medicare Baseline: 3.84x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Children's Hospital of Philadelphia is $1,729. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,350. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 3.84x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$4,350

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,729

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: $4,350 (965%)

Insurance Median: $1,729 (384%)

Cash: $4,350 (965% of Medicare)

Ins. Median: $1,729 (384% 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 384% of the Medicare baseline (a markup of 284%). 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
Geisinger Medical Assistance	$38	8%
Highmark Wholecare	$42	9%
Horizon Nj Health	$425	94%
Medicaid / KanCare	$493 - $918	109%
UnitedHealthcare	$496 - $3,062	110%
Health Partners	$563 - $1,049	125%
Aetna	$786 - $2,783	174%
Upmc Medical Assistance	$815 - $1,520	181%
Keystone First Chip	$926 - $1,726	205%
Keystone Health Plan East	$944 - $1,760	209%
Blue Cross Blue Shield	$1,054 - $2,230	234%
Geisinger Health Plan Commercial	$1,314 - $2,449	292%
Jefferson Health Plans	$1,413 - $2,633	313%
Cigna	$1,493 - $2,783	331%
Highmark	$1,493 - $2,783	331%
Qualcare	$1,643 - $3,062	365%
First Health Network	$1,941 - $3,618	431%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$2,389 - $4,453	530%
Private Health Care Systems	$2,389 - $4,453	530%
Choice Care Network	$2,688 - $5,010	596%

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 $4,350.
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 Children's Hospital of Philadelphia 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.