CMS Price Transparency Data

Blood transfusion

Facility: Wabash General Hospital 1

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,311
Cash Discount Price: $1,928
vs. Medicare Baseline: 2.91x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Wabash General Hospital 1 is $1,311. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,928. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.91x the Medicare baseline. Located in 1418 College Drive, Mount Carmel, IL.

Cash / Self-Pay

$1,928

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,311

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: $1,928 (428%)

Insurance Median: $1,311 (291%)

Cash: $1,928 (428% of Medicare)

Ins. Median: $1,311 (291% 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 291% of the Medicare baseline (a markup of 191%). 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
Blue Cross Blue Shield	$454 - $2,012	101%
UnitedHealthcare	$478 - $1,850	106%
Health Alliance Mcr Adv - All Plans	$488 - $731	108%
Aetna	$975 - $1,966	216%
Meridian Mcaid - All Plans	$975	216%
Molina Mcaid - All Plans	$975	216%
Healthlink Hmo	$1,079 - $1,619	239%
Cigna	$1,157 - $1,735	257%
Encore Combined Ip/Op Only	$1,157 - $1,735	257%
Hope Trust - All Plans	$1,157 - $1,735	257%
Healthlink Ppo - All Other Plans	$1,234 - $1,850	274%
Phcs - All Plans	$1,234 - $1,850	274%
Health Smart - All Plans	$1,311 - $1,966	291%
Hfn - All Plans	$1,311 - $1,966	291%
Multiplan - All Plans	$1,311 - $1,966	291%
Siho Network - All Plans	$1,311 - $1,966	291%
Encore Health Network Ip/Op Only - All Other Plans	$1,388 - $2,082	308%

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 $1,928.
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 Wabash General Hospital 1 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.