Blood transfusion
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $418
- Cash Discount Price: $1,226
- vs. Medicare Baseline: 0.93x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Indian Health Service Contracted [320198] | $37 | 8% |
| Blue Cross Blue Shield | $37 - $621 | 8% |
| Medicaid / KanCare | $129 - $472 | 29% |
| Medica Contracted [320239] | $188 - $686 | 42% |
| United Medical Resources Contracted [320454] | $348 - $1,271 | 77% |
| UnitedHealthcare | $348 - $1,271 | 77% |
| Cigna | $356 - $1,452 | 79% |
| Aetna | $389 - $1,603 | 86% |
| Humana | $389 - $418 | 86% |
| Aither Health Contracted [320449] | $413 - $1,509 | 92% |
| Imagine 360 Contracted [320494] | $413 - $1,509 | 92% |
| Yuzu Health Contracted [320521] | $413 - $1,509 | 92% |
| Ebms Contracted [320493] | $413 - $1,509 | 92% |
| Edison Health Solutions Contracted [320502] | $413 - $1,509 | 92% |
| American Healthcare Alliance Contracted [320020] | $413 - $1,509 | 92% |
| Workers Comp [20426] | $413 - $1,509 | 92% |
| Auxiant Contracted [320462] | $413 - $1,509 | 92% |
| Reflect Health Contracted [320492] | $413 - $1,509 | 92% |
| Healthlink Contracted [320179] | $413 - $1,509 | 92% |
| Mercy Benefit Admin Contracted [320251] | $413 - $1,509 | 92% |
| Cross Timbers Hospice [20098] | $418 | 93% |
| Medicare (plans) | $418 - $435 | 93% |
| Halo Hcr Inc Hospice Contracted [320432] | $418 | 93% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $418 | 93% |
| Dept Of Veteran Affairs Contracted [320106] | $418 | 93% |
| Kindful Hospice Contracted [320434] | $418 | 93% |
| Pace Of The Ozarks Contracted [320518] | $418 | 93% |
| Halo Hcr Inc Hospice [20432] | $418 | 93% |
| Mercy Hospice Okc [20252] | $418 | 93% |
| Tricare | $418 | 93% |
| Kindful Hospice [20434] | $418 | 93% |
| Elara Caring Aspire Hospice [20433] | $418 | 93% |
| Ambetter / Centene | $426 | 95% |
| Home State Health Plan Contracted [320187] | $426 | 95% |
| First Health Contracted [320128] | $439 - $1,603 | 97% |
| Providrs Care Network Contracted [320484] | $809 | 179% |
| Health Choice Contracted [320166] | $874 | 194% |
Consumer Guidance & Cost Commentary
For the CPT code 36430 (Blood transfusion) at Mercy Hospital Pittsburg, Inc., the facility's cash price of $1,226.00 is notably higher than the state average of $826.00, though it remains below the gross chargemaster of $1,886.00. While commercial insurance plans like Cigna and Aetna negotiate rates as high as $1,452 and $1,603 respectively, these figures often exceed the cash price, meaning patients with high-deductible plans might save money by paying the cash rate directly. It is important to note that many commercial payers, including UnitedHealthcare and Medica, have negotiated rates starting at $348, which are significantly lower than the cash price, so verifying your specific plan's allowed amount before scheduling is essential to avoid unexpected costs.
The facility's negotiated rates for this service range from $37 for the Indian Health Service to $874 for Health Choice, with a median negotiated rate of $418.00 across all payers. This median is substantially lower than the cash price, illustrating how insurance contracts can cap costs, but patients must ensure their deductibles are met before relying on these rates. Additionally, the facility's rate is 90% of the Medicare amount of $450.73, indicating a pricing structure that aligns closely with federal benchmarks rather than the inflated chargemaster. To maximize savings, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before check-in, as these upfront payment incentives can reduce the final bill by 20% to 5