CMS Price Transparency Data

Blood transfusion

Facility: Stephens County Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $456
Cash Discount Price: $476
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Stephens County Hospital is $456. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $476. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.01x the Medicare baseline. Located in 163 Hospital Drive, Toccoa, GA.

Cash / Self-Pay

$476

Average discount available for prompt cash payment at this facility.

Insurance Median

$456

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: $476 (106%)

Insurance Median: $456 (101%)

Cash: $476 (106% of Medicare)

Ins. Median: $456 (101% 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.

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
Amerigroup	$165 - $482	37%
Medicaid / KanCare	$165 - $497	37%
Blue Cross Blue Shield	$410 - $1,200	91%
Caresource	$425	94%
Medicare (plans)	$425	94%
Aetna	$435 - $1,275	97%
UnitedHealthcare	$451 - $1,320	100%
Cigna	$461 - $1,350	102%

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 $476.
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 Stephens 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.