CMS Price Transparency Data

Blood transfusion

Facility: Valley West Community Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $600
Cash Discount Price: $1,944
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Valley West Community Hospital is $600. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,944. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.33x the Medicare baseline. Located in 11 East Pleasant Avenue, Sandwich, IL.

Cash / Self-Pay

$1,944

Average discount available for prompt cash payment at this facility.

Insurance Median

$600

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: $1,944 (431%)

Insurance Median: $600 (133%)

Cash: $1,944 (431% of Medicare)

Ins. Median: $600 (133% 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
Blue Cross Blue Shield	$17 - $877	4%
Cigna	$17 - $519	4%
Countycare Il Cook Co [1607]	$17	4%
Family Health Network Hmo [1610]	$17	4%
Medicaid / KanCare	$17	4%
Meridian Health Plan Hmo [1604]	$17	4%
Global Excel [1712]	$204	45%
Humana	$204	45%
Aetna	$273 - $744	61%
Health'S Finest Network [126]	$483 - $913	107%
UnitedHealthcare	$539 - $1,074	120%
The Alliance [1703]	$584	130%
Choicecare [177]	$724	161%
Healthlink [125]	$806	179%
Multiplan/Phcs [142]	$859 - $1,074	191%
First Health Plan [6034]	$1,074	238%

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 $1,944.
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 Valley West 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.