CMS Price Transparency Data

Blood transfusion

Facility: Pocahontas Community Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $739
Cash Discount Price: $770
vs. Medicare Baseline: 1.64x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Pocahontas Community Hospital is $739. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $770. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.64x the Medicare baseline. Located in 606 N W 7Th Street, Pocahontas, IA.

Cash / Self-Pay

$770

Average discount available for prompt cash payment at this facility.

Insurance Median

$739

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: $770 (171%)

Insurance Median: $739 (164%)

Cash: $770 (171% of Medicare)

Ins. Median: $739 (164% 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
Molina	$385 - $770	85%
Wellpoint	$416 - $770	92%
Iowa Total Care	$428 - $770	95%
Aetna	$462 - $770	103%
Blue Cross Blue Shield	$647 - $770	144%
Health Partners	$727 - $732	161%
Humana	$732 - $770	162%
UnitedHealthcare	$739	164%
Cigna	$747	166%
Great West	$747	166%

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 $770.
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 Pocahontas Community 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.