CMS Price Transparency Data

Blood transfusion

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,056
Cash Discount Price: $891
vs. Medicare Baseline: 2.34x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Iowa Specialty Hospital - Clarion is $1,056. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $891. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.34x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$891

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,056

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: $891 (198%)

Insurance Median: $1,056 (234%)

Cash: $891 (198% of Medicare)

Ins. Median: $1,056 (234% 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 234% of the Medicare baseline (a markup of 134%). 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
Tricare	$349 - $541	77%
Triwest Va - All Plans	$349 - $541	77%
Wellmark Hmo	$455	101%
Wellmark Ppo - All Other Plans	$500	111%
Healthscope Stellar-All Plans	$594 - $921	132%
Auxiant Clarion Schools-All Plans	$731 - $1,134	162%
Health Partners Prestage	$844 - $1,309	187%
Health Partners Ish-All Other Plans	$900 - $1,396	200%
Aetna	$956 - $1,483	212%
UnitedHealthcare	$1,069 - $1,658	237%
Cigna	$1,091 - $1,693	242%
Midlands Choice-All Plans	$1,091 - $1,693	242%

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 $891.
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 Iowa Specialty Hospital - Clarion 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.