CMS Price Transparency Data

Blood transfusion

Facility: Unity Physicians Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,287
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.86x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Unity Physicians Hospital is $1,287. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.86x the Medicare baseline. Located in 4455 Edison Lakes Pkwy, Mishawaka, IN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,287

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%)

Insurance Median: $1,287 (286%)

Ins. Median: $1,287 (286% 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 286% of the Medicare baseline (a markup of 186%). 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
Aarp Supplemental	$354 - $36,351	79%
Aetna	$354 - $36,351	79%
Blue Cross Blue Shield	$354 - $56,407	79%
Cigna	$354 - $36,351	79%
Department Of Va	$354 - $36,351	79%
Medicare (plans)	$354 - $36,351	79%
Mhs Healthy Indiana Plan	$354 - $36,351	79%
Railroad Retirement	$354 - $36,351	79%
UnitedHealthcare	$354 - $76,226	79%
Three Rivers Provider Network	$425 - $43,621	94%
Humana	$495 - $100,000	110%
Encore	$637 - $65,431	141%
Provider Network Of America	$708 - $72,702	157%
All Savers	$950 - $76,226	211%
Medica	$950 - $76,226	211%
Medica Ifb	$950 - $76,226	211%
Oxford	$950 - $76,226	211%
Nalc	$1,065 - $76,226	236%
Sagamore Health Network	$1,065 - $76,226	236%
Multiplan	$1,154	256%
Multiplan Wc	$1,420	315%

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 $X.
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 Unity Physicians 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.