CMS Price Transparency Data

Blood transfusion

Facility: Adventist Health Clearlake

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,233
Cash Discount Price: $527
vs. Medicare Baseline: 2.74x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Adventist Health Clearlake is $1,233. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $527. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.74x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$527

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,233

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: $527 (117%)

Insurance Median: $1,233 (274%)

Cash: $527 (117% of Medicare)

Ins. Median: $1,233 (274% 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 274% of the Medicare baseline (a markup of 174%). 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 Mcr Adv	$307	68%
Kaiser Mcr Adv	$307	68%
Tricare	$307	68%
Blue Cross Blue Shield	$320 - $6,703	71%
UnitedHealthcare	$338 - $1,221	75%
Ah Employee Health Plan - All Plans	$615	136%
Aetna	$1,094	243%
Western Growers- All Plans	$1,098	244%
Blue Shield Epn - All Other Plans	$1,124	249%
Blue Shield Non-Epn	$1,124	249%
First Health- All Plans	$1,171	260%
Healthnet- All Plans	$1,200	266%
Foundation- All Plans	$1,244	276%
Health Mgmt Network- All Plans	$1,244	276%
Humana	$1,244	276%
Phcs- All Plans	$1,244	276%
Cigna	$1,318	292%
Interplan- All Plans	$1,318	292%
Kaiser- All Other Plans	$1,318	292%
Three Rivers Provider Network- All Plans	$1,318	292%
Bc Managed Mcal	$1,464	325%
Medi-Cal	$1,464	325%
Partnership Mcal - All Plans	$2,416	536%

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 $527.
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 Clearlake 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.