CMS Price Transparency Data

Blood transfusion

Facility: Adventist Health Tulare

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,415
Cash Discount Price: $434
vs. Medicare Baseline: 3.14x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Adventist Health Tulare is $1,415. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $434. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 3.14x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$434

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,415

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: $434 (96%)

Insurance Median: $1,415 (314%)

Cash: $434 (96% of Medicare)

Ins. Median: $1,415 (314% 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 314% of the Medicare baseline (a markup of 214%). 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	$24 - $5,421	5%
Blue Shield Mcare	$567	126%
Dignity Mcr Op Only - All Other Plans	$567	126%
Fhcn Pace Mcr Adv - All Plans	$567	126%
Medicare (plans)	$567	126%
Prime Health - All Plans	$567	126%
Tricare	$567	126%
UnitedHealthcare	$567	126%
Blue Shield Epn	$688 - $902	153%
Prison Hlthcre - All Plans	$726	161%
Cal Forensic Med Grp - All Plans	$738	164%
Bright Health - All Plans	$823	183%
Blue Shield-All Other Plans	$951 - $1,248	211%
Cigna	$1,008 - $1,322	224%
Ah Employee Health Plan - All Plans	$1,021	227%
Incentive Hlth - All Plans	$1,021	227%
Western Growers - All Plans	$1,023 - $1,342	227%
Aetna	$1,274 - $1,670	283%
Network By Design-All Plans	$1,415 - $1,856	314%
Hs Interplan-All Plans	$1,459 - $1,913	324%
Healthnet Hmo/Ppo - All Other Plans	$1,512	335%
Multiplan - All Plans	$1,850 - $2,427	410%
Medi-Cal	$2,177 - $2,855	483%
Dignity Mcal Op Only	$2,395 - $3,140	531%
Independence Op Only - All Plans	$2,395 - $3,140	531%
Ccipa Medi-Cal - All Plans	$2,830 - $3,712	628%
Healthnet Medi-Cal	$2,852 - $3,740	633%

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 $434.
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 Tulare 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.