Blood transfusion
Facility: Pratt Regional Medical Center
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $326
- Cash Discount Price: $251
- vs. Medicare Baseline: 0.72x 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 |
|---|---|---|
| Christian Health Aid | $89 - $621 | 20% |
| UnitedHealthcare | $98 - $845 | 22% |
| Health Partners Of Kansas | $100 - $704 | 22% |
| Aetna | $106 - $745 | 24% |
| Choicecare | $118 - $828 | 26% |
| Celtic Insurance Company | $402 | 89% |
| Healthy Blue | $414 | 92% |
Consumer Guidance & Cost Commentary
For the CPT code 36430 (Blood transfusion) at Pratt Regional Medical Center in Pratt, KS, the cash price of $251.00 is lower than the facility's negotiated rates with major payers like UnitedHealthcare and Aetna, which range from $98 to $845. This price difference highlights a key billing principle: for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price directly can be significantly cheaper than relying on insurance, which may result in a higher allowed amount due to administrative overhead and contract dynamics. While the facility's cash rate is competitive, patients should verify their specific plan's deductible status and ask the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing costly insurance claims processing.
The facility's negotiated rates vary widely across different insurance carriers, with the lowest allowed amount being $89 from Christian Health Aid and the highest reaching $845 from UnitedHealthcare. It is important to note that these negotiated rates often exceed the cash price because they include administrative costs for claims management and utilization review, which can inflate the baseline price by 20% to 40%. If a patient receives care from an out-of-network provider or encounters services that are not covered under their plan, they may face balance billing for the difference between the provider's full charge and the insurance allowed amount. To avoid unexpected costs, patients should request an itemized bill to review specific CPT codes and ensure no unbundled charges or services not rendered are included, and they should dispute any surprise bills in writing rather than accepting summary invoices or signing away their