CMS Price Transparency Data

Blood transfusion

Facility: Adventist Health St Helena

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,175
Cash Discount Price: $290
vs. Medicare Baseline: 2.61x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Adventist Health St Helena is $1,175. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $290. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.61x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$290

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,175

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: $290 (64%)

Insurance Median: $1,175 (261%)

Cash: $290 (64% of Medicare)

Ins. Median: $1,175 (261% 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 261% of the Medicare baseline (a markup of 161%). 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 Shield Bh Mcr Adv	$586	130%
Blue Shield Mcr Adv	$586	130%
Kaiser Mcr Adv	$586	130%
Tricare	$586	130%
UnitedHealthcare	$586 - $1,275	130%
Va Mcr - All Other Plans	$586	130%
Blue Shield Behav Hlth	$842 - $900	187%
Blue Shield Non-Epn	$868 - $928	193%
Blue Shield Epn-All Other Plans	$881 - $942	195%
Aetna	$972 - $1,040	216%
Phcs-All Plans	$1,028 - $1,100	228%
Ah Employee Health Plan - All Plans	$1,055	234%
Western Growers-All Plans	$1,085 - $1,160	241%
Healthnet-All Plans	$1,146 - $1,226	254%
Interplan-All Plans	$1,216 - $1,300	270%
Choicecare-All Plans	$1,309 - $1,400	290%
Beech Street-All Plans	$1,402 - $1,500	311%
Cigna	$1,496 - $1,600	332%
Kaiser-All Other Plans	$1,533 - $1,640	340%
Health Management Network-All Plans	$1,590 - $1,700	353%
Galaxy Network-All Plans	$1,683 - $1,800	373%
Three Rivers-All Plans	$1,683 - $1,800	373%
Va Medi-Cal	$1,870 - $2,000	415%
Blue Cross Blue Shield	$3,919 - $5,298	869%

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 $290.
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 Adventist Health St Helena 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.