CMS Price Transparency Data

Blood transfusion

Facility: Franciscan Health Michigan City

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,522
Cash Discount Price: $487
vs. Medicare Baseline: 3.38x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Franciscan Health Michigan City is $1,522. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $487. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 3.38x the Medicare baseline. Located in 3500 Franciscan Way, Michigan City, IN.

Cash / Self-Pay

$487

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,522

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: $487 (108%)

Insurance Median: $1,522 (338%)

Cash: $487 (108% of Medicare)

Ins. Median: $1,522 (338% 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 338% of the Medicare baseline (a markup of 238%). 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
Medicare (plans)	$467	104%
Aetna	$476 - $2,174	106%
Managed Care [2000]	$476 - $2,608	106%
Blue Cross Blue Shield	$580 - $1,610	129%
Commercial [2001]	$695 - $2,898	154%
United Medical Resources [1158]	$695 - $1,736	154%
United Medical Resources [1301]	$695 - $1,930	154%
UnitedHealthcare	$695 - $1,930	154%
Cigna	$701 - $2,029	156%
Great West Insurance [1055]	$701 - $1,750	156%
Workers Comp [1172]	$934	207%
Unicare [1150]	$1,610	357%

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 $487.
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 Franciscan Health Michigan City 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.