CMS Price Transparency Data

Blood transfusion

Facility: Kootenai Health

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $456
Cash Discount Price: $979
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Kootenai Health is $456. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $979. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.01x the Medicare baseline. Located in 2003 Kootenai Health Way, Coeur D'Alene, ID.

Cash / Self-Pay

$979

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: $979 (217%)

Insurance Median: $456 (101%)

Cash: $979 (217% 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
Coordinated Care Of Washington	$21	5%
Molina Healthcare Of Idaho	$21 - $483	5%
Molina Healthcare Of Washington	$21	5%
Magellan	$29 - $32	6%
Wellpoint	$29 - $32	6%
Blue Cross Blue Shield	$43 - $1,331	10%
Humana	$43 - $456	10%
Premera	$43 - $806	10%
Regence Blue Shield Of Idaho	$43 - $456	10%
UnitedHealthcare	$43 - $1,174	10%
Pacificsource	$44 - $1,069	10%
Aetna	$45 - $1,083	10%
Group Health/Kaiser	$46 - $1,642	10%
Mountain Health Co-Op	$1,011	224%
Cigna	$1,069 - $1,084	237%
Interwest Health	$1,109	246%
First Choice Health (Ameriben)	$1,113 - $1,130	247%

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 $979.
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 Kootenai Health 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.