CMS Price Transparency Data

Blood transfusion

Facility: Cook Childrens Medical Center Prosper

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,009
Cash Discount Price: $1,646
vs. Medicare Baseline: 2.24x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Cook Childrens Medical Center Prosper is $1,009. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,646. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.24x the Medicare baseline. Located in 4100 W University Drive, Prosper, TX.

Cash / Self-Pay

$1,646

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,009

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: $1,646 (365%)

Insurance Median: $1,009 (224%)

Cash: $1,646 (365% of Medicare)

Ins. Median: $1,009 (224% 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 224% of the Medicare baseline (a markup of 124%). 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
Health Plan W/O Uhrip	$729 - $1,185	162%
Superior Health	$729	162%
Wellpoint	$766	170%
Blue Cross Blue Shield	$788 - $1,975	175%
United Community	$812 - $878	180%
UnitedHealthcare	$966 - $1,865	214%
Aetna	$1,009 - $1,865	224%
Beacon	$1,009 - $1,185	224%
El Paso Health First	$1,009 - $1,185	224%
Firstcare	$1,009 - $1,755	224%
Health Plan W. Uhrip	$1,009	224%
Tx Children Health	$1,009 - $1,185	224%
S&W Health	$1,843	409%
Cigna	$1,865	414%
Healthscope	$1,865	414%
Imagine Health	$1,865	414%
Humana	$1,909 - $1,931	424%
Multiplan	$1,909	424%
First Health	$1,931	428%
Galaxy Health	$1,975	438%
Healthsmart	$1,975	438%
Usamco	$2,019	448%

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 $1,646.
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 Cook Childrens Medical Center Prosper 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.