CMS Price Transparency Data

Blood transfusion

Facility: Hamilton Memorial Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $413
Cash Discount Price: $458
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Hamilton Memorial Hospital is $413. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $458. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.92x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$458

Average discount available for prompt cash payment at this facility.

Insurance Median

$413

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: $458 (102%)

Insurance Median: $413 (92%)

Cash: $458 (102% of Medicare)

Ins. Median: $413 (92% 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	$44 - $485	10%
Blue Cross Blue Shield	$44 - $490	10%
Health Alliance	$44 - $431	10%
Medicare (plans)	$44 - $215	10%
UnitedHealthcare	$44 - $386	10%
Wellcare	$44 - $215	10%
Medicaid / KanCare	$200 - $215	44%
Humana	$215	48%
Alliance Coal	$377	84%
Healthscope	$377	84%
Wellfirst (Ssmhic)	$377	84%
Hope Trust	$404	90%
Cigna	$423	94%
Hfn, Inc	$431 - $485	96%
Healthlink	$458 - $485	102%
Multiplan	$458	102%
Siho	$485	108%
Three Rivers Provider	$485	108%
Healthsmart	$512	114%
Stratose	$512	114%

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 $458.
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 Hamilton Memorial 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.