CMS Price Transparency Data

Blood transfusion

Facility: Elkhart General Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $986
Cash Discount Price: $880
vs. Medicare Baseline: 2.19x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Elkhart General Hospital is $986. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $880. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.19x the Medicare baseline. Located in 600 E Blvd, Elkhart, IN.

Cash / Self-Pay

$880

Average discount available for prompt cash payment at this facility.

Insurance Median

$986

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: $880 (195%)

Insurance Median: $986 (219%)

Cash: $880 (195% of Medicare)

Ins. Median: $986 (219% 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 219% of the Medicare baseline (a markup of 119%). 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
Devoted Healthcare	$206 - $481	46%
Blue Cross Blue Shield	$216 - $1,366	48%
Mclaren (Mi	$245	54%
UnitedHealthcare	$245 - $1,554	54%
Aetna	$458 - $1,565	102%
Humana	$458 - $1,618	102%
Pace	$458	102%
Cha	$618 - $1,803	137%
Immergrun	$618 - $1,850	137%
Mhs	$670 - $3,006	149%
Php	$670 - $1,618	149%
Plain Church	$687 - $1,850	152%
Caresource	$733 - $3,006	163%
Cigna	$742 - $1,757	165%
Multiplan	$742 - $1,665	165%
Signature	$752 - $1,688	167%
Encore	$762 - $1,711	169%
Heartland	$1,030 - $2,312	229%
Mdwise	$1,339 - $3,006	297%

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 $880.
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 Elkhart General 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.