CMS Price Transparency Data

Blood transfusion

Facility: Margaretville Memorial Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $788
Cash Discount Price: $776
vs. Medicare Baseline: 1.75x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Margaretville Memorial Hospital is $788. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $776. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.75x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$776

Average discount available for prompt cash payment at this facility.

Insurance Median

$788

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: $776 (172%)

Insurance Median: $788 (175%)

Cash: $776 (172% of Medicare)

Ins. Median: $788 (175% 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
Blue Cross Blue Shield	$70 - $22,000	16%
Mvp	$177	39%
Mvp Hmo/Ppo	$208 - $823	46%
Mvp Gold (McR)	$322 - $22,000	71%
UnitedHealthcare	$322 - $22,000	71%
Medicare (plans)	$322 - $23,540	71%
Hamaspik (McR)	$322 - $22,000	71%
Aetna	$322 - $22,000	71%
Affinity By Molina McR	$338 - $23,100	75%
Cdphp	$354 - $24,200	79%
Emblem Ghi/Hip Hmo/Epo/Pos	$490 - $788	109%
Oxford Exchange	$490 - $3,326	109%
Emblem Ghi/Hip Ppo/Cbp	$490 - $788	109%
Emblem Select Care (Exchange)	$490 - $788	109%
Magnacare Standard	$512 - $823	114%
Magnacare Preferred	$512 - $3,537	114%
Mvp Exchange	$512 - $823	114%
Todays Options	$531 - $854	118%
Self-Pay	$559 - $3,781	124%
Multiplan	$599 - $964	133%
First Health	$658 - $1,058	146%
Oxford	$3,101 - $3,447	688%
Magnacare	$3,337	740%
Emblem	$7,576	1681%

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 $776.
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 Margaretville Memorial Hospital 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.