CMS Price Transparency Data

Blood transfusion

Facility: Samuel Mahelona Memorial Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,040
Cash Discount Price: $1,338
vs. Medicare Baseline: 2.31x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Samuel Mahelona Memorial Hospital is $1,040. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,338. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.31x the Medicare baseline. Located in 4800 Kawaihau Road, Kapaa, HI.

Cash / Self-Pay

$1,338

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,040

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: $1,338 (297%)

Insurance Median: $1,040 (231%)

Cash: $1,338 (297% of Medicare)

Ins. Median: $1,040 (231% 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 231% of the Medicare baseline (a markup of 131%). 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
UnitedHealthcare	$33 - $1,030	7%
Hawaii Medical Service Association	$563 - $1,030	125%
Kaiser Permanente	$1,030 - $1,853	229%
Humana	$1,030	229%
Alohacare	$1,030	229%
Ohana Health Plan	$1,030	229%
Devoted Health	$1,132	251%
University Health Alliance	$1,153	256%
Health Management Network	$1,750	388%
Hawaii Western Management Group	$1,956	434%
Mdx Hawaii	$1,997	443%

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 $1,338.
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 Samuel Mahelona Memorial 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.