CMS Price Transparency Data

Blood transfusion

Facility: East Morgan County Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,019
Cash Discount Price: $781
vs. Medicare Baseline: 2.26x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at East Morgan County Hospital is $1,019. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $781. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.26x the Medicare baseline. Located in 2400 W Edison St, Brush, CO.

Cash / Self-Pay

$781

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,019

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: $781 (173%)

Insurance Median: $1,019 (226%)

Cash: $781 (173% of Medicare)

Ins. Median: $1,019 (226% 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 226% of the Medicare baseline (a markup of 126%). 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
Pinnacol Assurance Workers Comp	$477 - $716	106%
Aetna	$487 - $1,579	108%
Banner Health	$487 - $730	108%
Blue Cross Blue Shield	$487 - $1,393	108%
Clear Spring Health	$487 - $730	108%
Healthspring Life & Health Insurance Company, Inc.	$487 - $730	108%
Medica	$487 - $1,414	108%
Medicare (plans)	$487 - $730	108%
Triwest Healthcare Alliance Corp - Va Ccn	$487 - $730	108%
UnitedHealthcare	$487 - $1,579	108%
Longevity	$501 - $752	111%
Humana	$516 - $774	114%
Devoted Health Services	$535 - $803	119%
Assist Health Group	$584 - $876	130%
Denver Health Medical Plan	$906 - $1,358	201%
Apostrophe, Inc.	$1,019 - $1,528	226%
First Choice Health Network	$1,019 - $1,528	226%
Hue Health, Inc	$1,075 - $1,613	239%
Rocky Mountain Health Plans	$1,075 - $1,613	239%
Multiplan	$1,098 - $1,647	244%

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 $781.
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 East Morgan County Hospital 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.