CMS Price Transparency Data

Blood transfusion

Facility: Pulaski Memorial Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $952
Cash Discount Price: $1,333
vs. Medicare Baseline: 2.11x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Pulaski Memorial Hospital is $952. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,333. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.11x the Medicare baseline. Located in 616 E 13Th St, Winamac, IN.

Cash / Self-Pay

$1,333

Average discount available for prompt cash payment at this facility.

Insurance Median

$952

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: $1,333 (296%)

Insurance Median: $952 (211%)

Cash: $1,333 (296% of Medicare)

Ins. Median: $952 (211% 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 211% of the Medicare baseline (a markup of 111%). 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
Ambetter / Centene	$148 - $1,033	33%
Blue Cross Blue Shield	$148 - $3,333	33%
Caresource Mcaid Hip	$148 - $1,033	33%
Caresource Mcare Hmo	$148 - $1,033	33%
Cenpatico Mcaid Hip	$148 - $1,033	33%
Mdwise Mcaid Hip - All Other Plans	$148 - $1,033	33%
Mhs Mcaid Hip	$148 - $1,033	33%
UnitedHealthcare	$148 - $3,333	33%
Humana	$149 - $2,679	33%
Mhs Mcare Allwell	$149 - $1,043	33%
Aetna	$171 - $1,200	38%
Caresource Exch Hmo Hix - All Other Plans	$185 - $1,291	41%
Sagamore Rose Acre	$355 - $2,483	79%
Sagamore - All Other Plans	$360 - $2,520	80%
Encore Ppo - All Other Plans	$405 - $2,833	90%
Community Health Alliance - All Plans	$424 - $2,966	94%
Encore Workers Comp	$429 - $2,999	95%
Multiplan - All Plans	$429 - $2,999	95%
Cigna	$452 - $3,166	100%
Caresource Mcaid Hhw	$476 - $3,333	106%
Cenpatico Mcaid Hhw - All Other Plans	$476 - $3,333	106%
Mdwise Mcaid Hcc	$476 - $3,333	106%
Mdwise Mcaid Hhw	$476 - $3,333	106%
Mhs Mcaid Hhw/Hcc	$476 - $3,333	106%

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 $1,333.
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 Pulaski Memorial 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.