BACKGROUND: little is known about the economics of acquiring and processing the more than 14 million units of red blood cells used annually in the US. OBJECTIVE: to determine the average price paid by hospitals to suppliers for a unit of red blood cells and to identify cost variations by region and facility type and size. A secondary objective was to examine costs for additional blood components as well as costs for blood-related processes performed by hospitals. Qualitative input was sought to identify potential cost drivers. METHODS: a cross-sectional survey was performed of a randomized sample of hospital-based blood bank and transfusion service directors. The survey instrument assessed costs of specific blood components and services as incurred by hospitals. Analysis of variance was performed to test for significant variation in costs for red blood cells by geographic region and division, facility type and bed capacity. RESULTS: a total of 213 surveys were completed. The mean (SD) acquisition cost for one unit of red blood cells purchased from a supplier (n = 204) was $US210.74 ± 37.9 and the mean charge to the patient (n = 167) was $US343.63 ± 135. There was significant statistical variation in acquisition cost by US census region (p < 0.0001) and division (p < 0.0001). Teaching hospitals were more likely to receive volume discounts than other facility types. The mean prices paid per unit for fresh frozen plasma (n = 167) and apheresis platelets (n = 153) were $US60.70 ± 20 and $US533.90 ± 69, respectively. The median cost for mandated screening performed onsite (n = 56) was $US50.00 ± 120 and the median storage and retrieval cost (n = 46) was $US68.00 ± 81 per unit. A total of 28% of respondents reported that costs for acquisition, screening and transfusion had 'increased dramatically' over the past 5 years and 23% reported that blood shortages were a significant problem. CONCLUSIONS: the cost of blood continues to increase and price varies by geography. However, the rate of increase in acquisition costs for red blood cells appears to be slowing. This information should be used by organizations and policy makers to improve financing and utilization management for blood components and services.