CMS Price Transparency Data

Blood transfusion

Facility: Pinckneyville Community Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,074
Cash Discount Price: $1,635
vs. Medicare Baseline: 2.38x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Pinckneyville Community Hospital is $1,074. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,635. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.38x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$1,635

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,074

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: $1,635 (363%)

Insurance Median: $1,074 (238%)

Cash: $1,635 (363% of Medicare)

Ins. Median: $1,074 (238% 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 238% of the Medicare baseline (a markup of 138%). 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
Aetna	$35 - $2,369	8%
UnitedHealthcare	$36 - $2,158	8%
Umwa Mcr Adv - All Plans	$44 - $974	10%
Wellcare Mcr Adv - All Plans	$44 - $974	10%
Cigna	$53 - $2,171	12%
Blue Cross Blue Shield	$76 - $2,204	17%
Healthlink Hmo	$91 - $2,066	20%
Healthlink Ppo - All Other Plans	$91 - $2,171	20%
Phcs Savility	$124 - $2,237	28%
Multiplan - All Plans	$131 - $2,369	29%
Phcs - All Other Plans	$131 - $2,158	29%
Ambetter / Centene	$146 - $2,204	32%
Medicaid / KanCare	$146 - $2,204	32%
Humana	$485 - $974	108%
Healthlink Work Comp	$1,081 - $2,171	240%

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 $1,635.
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 Pinckneyville 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.