CMS Price Transparency Data

Blood transfusion

Facility: Rochelle Community Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $935
Cash Discount Price: $1,182
vs. Medicare Baseline: 2.07x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Rochelle Community Hospital is $935. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,182. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.07x the Medicare baseline. Located in 900 N 2Nd St, Rochelle, IL.

Cash / Self-Pay

$1,182

Average discount available for prompt cash payment at this facility.

Insurance Median

$935

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: $1,182 (262%)

Insurance Median: $935 (207%)

Cash: $1,182 (262% of Medicare)

Ins. Median: $935 (207% 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 207% of the Medicare baseline (a markup of 107%). 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	$409 - $836	91%
Health Alliance Mcr Adv	$409 - $418	91%
Humana	$409 - $955	91%
UnitedHealthcare	$409 - $1,075	91%
Va Ccn - All Plans	$409 - $418	91%
Blue Cross Blue Shield	$417 - $1,194	93%
Wellcare Mcr Adv - All Plans	$417 - $426	93%
Medicaid / KanCare	$698	155%
Cigna	$877 - $896	195%
Osf Dan Ppo - All Plans	$877 - $896	195%
Beech Street-All Plans	$935 - $955	207%
First Health - All Plans	$935 - $955	207%
Health Alliance-All Other Plans	$935 - $955	207%
Ecoh-All Plans	$994 - $1,015	221%
Hfn-All Plans	$994 - $1,015	221%
The Alliance-All Plans	$994 - $1,015	221%
Quartz Health Solutions-All Plans	$1,029 - $1,051	228%
Multiplan-All Plans	$1,099 - $1,122	244%

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 $1,182.
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 Rochelle 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.