CMS Price Transparency Data

Blood transfusion

Facility: Modoc Medical Center

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $956
Cash Discount Price: $1,012
vs. Medicare Baseline: 2.12x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Modoc Medical Center is $956. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,012. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.12x the Medicare baseline. Located in 1111 N Nagle Street, Alturas, CA.

Cash / Self-Pay

$1,012

Average discount available for prompt cash payment at this facility.

Insurance Median

$956

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: $1,012 (225%)

Insurance Median: $956 (212%)

Cash: $1,012 (225% of Medicare)

Ins. Median: $956 (212% 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 212% of the Medicare baseline (a markup of 112%). 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
Multiplan Wc	$428	95%
Ntwrks By Design Wc - All Plans	$446	99%
Integrated Hp Wc	$451	100%
Blue Shield Mcr Adv	$548	122%
Blue Shield Va	$548	122%
UnitedHealthcare	$548 - $961	122%
Tricare	$577	128%
Healthnet Mcr Adv	$582	129%
Blue Cross Blue Shield	$832 - $924	185%
Blue Shield Exch	$832	185%
Blue Shield Comm - All Other Plans	$924	205%
Carelon - All Plans	$924	205%
Corvel - All Plans	$951	211%
Aetna	$961	213%
Coventry/First Health - All Plans	$961	213%
Galaxy Health - All Plans	$961	213%
Healthnet Comm - All Other Plans	$961	213%
Hmn - All Plans	$961	213%
Integrated Hp - All Other Plans	$961	213%
Interplan - All Plans	$961	213%
Multiplan - All Other Plans	$961	213%
Superior Ca Ppo - All Plans	$961	213%
Adv Med Mgmt - All Plans	$1,012	225%
Medi-Cal	$1,012	225%
Medi-Cal 7/1/24	$1,012	225%
Partnership Hp - All Plans	$3,541	786%

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 $1,012.
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 Modoc Medical Center 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.