CMS Price Transparency Data

Blood transfusion

Facility: Kirby Medical Center

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $530
Cash Discount Price: $1,027
vs. Medicare Baseline: 1.18x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Kirby Medical Center is $530. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,027. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.18x the Medicare baseline. Located in 1000 Medical Center Drive, Monticello, IL.

Cash / Self-Pay

$1,027

Average discount available for prompt cash payment at this facility.

Insurance Median

$530

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: $1,027 (228%)

Insurance Median: $530 (118%)

Cash: $1,027 (228% of Medicare)

Ins. Median: $530 (118% 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
Aetna	$26 - $1,198	6%
Blue Cross Blue Shield	$26 - $1,677	6%
Meridian	$26 - $530	6%
Molina	$27 - $546	6%
UnitedHealthcare	$44 - $1,179	10%
Wellcare	$44 - $530	10%
Humana	$53 - $1,283	12%
Zelis (Hfn)	$55 - $1,540	12%
Catepillar, Inc.	$88 - $1,454	20%
Cigna	$1,369	304%
Healthlink	$1,540	342%
Multiplan/Phcs	$1,625	361%

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 $1,027.
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 Kirby 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.