CMS Price Transparency Data

Blood transfusion

Facility: Mercy Hospital of Buffalo

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $18
Cash Discount Price: $556
vs. Medicare Baseline: 0.04x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Mercy Hospital of Buffalo is $18. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $556. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.04x the Medicare baseline. Located in 565 Abbott Road, Buffalo, NY.

Cash / Self-Pay

$556

Average discount available for prompt cash payment at this facility.

Insurance Median

$18

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: $556 (123%)

Insurance Median: $18 (4%)

Cash: $556 (123% of Medicare)

Ins. Median: $18 (4% 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
Beacon Essential [350122]	$8	2%
Crime Victims [100176]	$8	2%
UnitedHealthcare	$8 - $10	2%
Tuscarora Nation [550120]	$8	2%
Excellus Rochester McD [350117]	$8	2%
Univera Healthcare Essential [100170]	$8 - $10	2%
Medicaid / KanCare	$8 - $227	2%
Blue Cross Blue Shield	$18 - $50	4%
Fidelis Essential [100163]	$18	4%
Molina Essential [100167]	$18	4%
Hospice [550001]	$40	9%
Catholic Health Life Pace [400005]	$40	9%
Medicare (plans)	$41 - $424	9%
Amerigroup [350102]	$50	11%
No Fault [114001]	$75	17%
Independent Health Essential [100166]	$228 - $273	51%
Independent Health [100165]	$353 - $512	78%
Iha First Choice [800001]	$461	102%

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 $556.
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 Mercy Hospital of Buffalo 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.