CMS Price Transparency Data

Blood transfusion

Facility: Lost Rivers Medical Center

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,341
Cash Discount Price: $1,238
vs. Medicare Baseline: 2.98x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Lost Rivers Medical Center is $1,341. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,238. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.98x the Medicare baseline. Located in 551 Highland Drive, Arco, ID.

Cash / Self-Pay

$1,238

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,341

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: $1,238 (275%)

Insurance Median: $1,341 (298%)

Cash: $1,238 (275% of Medicare)

Ins. Median: $1,341 (298% 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 298% of the Medicare baseline (a markup of 198%). 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
Select Health Brightpath-All Other Plans	$801 - $1,605	178%
Tricare	$801 - $1,605	178%
Provider Network Of America-All Plans	$811	180%
Ihcn Brightpath-All Other Plans	$845 - $1,694	187%
Blue Cross Blue Shield	$890 - $2,830	197%
Humana	$890 - $2,830	197%
Ihcn Brightpath Mcr Adv	$890 - $1,783	197%
Molina Mcr Adv-All Plans	$890 - $1,783	197%
Pacificsource Mcr Adv	$890 - $1,783	197%
Regence/Brightpth Slhp Mcr	$890 - $1,783	197%
Select Health Mcr Adv	$890 - $1,783	197%
Prime Hlth Mcr Adv	$934 - $1,872	207%
Aetna	$960 - $2,660	213%
Cigna	$1,313 - $2,632	291%
First Choice-All Plans	$1,313 - $2,632	291%
Pacificsource Navigator-All Other Plans	$1,341 - $2,688	298%
UnitedHealthcare	$1,341 - $2,688	298%
Va Pccc-All Plans	$1,341 - $2,688	298%
Altius Health Plan-All Plans	$1,370 - $2,745	304%
Regence Blue Shield-All Other Plans	$1,384 - $2,773	307%

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 $1,238.
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 Lost Rivers 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.