CMS Price Transparency Data

Blood transfusion

Facility: St Luke's Patients Medical Center

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,041
Cash Discount Price: $560
vs. Medicare Baseline: 2.31x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at St Luke's Patients Medical Center is $1,041. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $560. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.31x the Medicare baseline. Located in 4600 East Sam Houston Parkway South, Pasadena, TX.

Cash / Self-Pay

$560

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,041

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: $560 (124%)

Insurance Median: $1,041 (231%)

Cash: $560 (124% of Medicare)

Ins. Median: $1,041 (231% 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 231% of the Medicare baseline (a markup of 131%). 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
Blue Cross Blue Shield	$26 - $438	6%
Chc	$29	6%
Tchp	$29	6%
United	$31 - $2,749	7%
Wellpoint	$31 - $657	7%
Cigna	$438 - $5,160	97%
Humana	$438 - $2,430	97%
Kelsey	$438	97%
Aetna	$447 - $1,217	99%
Amerivantage	$451	100%
Devoted	$469	104%
Scanhealth	$469	104%
Ambetter / Centene	$657	146%
Community Health Choice	$657	146%
Bright Health	$664	147%
Coventry	$1,041	231%
First Health	$1,041	231%
PHCS	$1,041	231%
Healthsmart	$1,121	249%
Multiplan	$1,201	266%

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 $560.
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 St Luke's Patients Medical 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.