CMS Price Transparency Data

Blood transfusion

Facility: St Luke's Wood River Medical Center

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,089
Cash Discount Price: $1,224
vs. Medicare Baseline: 2.42x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at St Luke's Wood River Medical Center is $1,089. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,224. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.42x the Medicare baseline. Located in 100 Hospital Drive, Ketchum, ID.

Cash / Self-Pay

$1,224

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,089

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: $1,224 (272%)

Insurance Median: $1,089 (242%)

Cash: $1,224 (272% of Medicare)

Ins. Median: $1,089 (242% 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 242% of the Medicare baseline (a markup of 142%). 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	$589 - $1,108	131%
Commercial [1028]	$698 - $1,187	155%
Medicare (plans)	$698 - $712	155%
Veterans Affairs [1056]	$698	155%
Blue Cross Blue Shield	$705 - $1,047	156%
Aetna	$767 - $1,163	170%
Moda [1055]	$1,077	239%
Geha [1065]	$1,108	246%
United Medical Resources [1051]	$1,108	246%
Cigna	$1,138	252%
Providence [1022]	$1,138	252%
Pacificsource [1020]	$1,151	255%
First Health [1064]	$1,163 - $1,187	258%
Webtpa [1071]	$1,163	258%

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 $1,224.
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 St Luke's Wood River Medical Center 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.