Blood transfusion
Facility: Nmc Health
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $639
- Cash Discount Price: $668
- vs. Medicare Baseline: 1.42x 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 |
|---|---|---|
| Bluestem Pace | $399 | 89% |
| Blue Cross Blue Shield | $516 | 114% |
| Wppa | $525 | 116% |
| Occunet | $572 | 127% |
| Samaritan Ministries International | $620 | 138% |
| Medincrease Health Plan | $620 | 138% |
| Medicaid / KanCare | $639 | 142% |
| Leading Age | $639 | 142% |
| Prime Health Services | $716 | 159% |
| Aetna | $786 - $3,507 | 174% |
| UnitedHealthcare | $859 | 191% |
| Cigna | $906 | 201% |
Consumer Guidance & Cost Commentary
For CPT code 36430, a blood transfusion, Nmc Health in Newton, KS, lists a gross charge of $954.00. The facility's cash median rate is $668.00, which is lower than the negotiated rates paid by most major insurers, ranging from $399 for Bluestem Pace to $906 for Cigna. While the facility's negotiated average of $639.00 is below the gross charge, it remains higher than the cash price. For patients with high-deductible plans, paying the cash rate of $668.00 upfront may be more cost-effective than relying on insurance, as the insurer's allowed amount often exceeds the cash price. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling to ensure they receive the lowest possible rate.
This service is benchmarked against the Medicare rate of $450.73, which serves as the objective baseline for fair pricing. The facility's cash rate is approximately 1.47 times the Medicare amount, while the gross charge is significantly higher. It is important to note that balance billing can occur if a patient receives care from an out-of-network provider, where the provider bills the difference between their full charge and the insurance allowed amount. To avoid unexpected costs, patients should request a detailed, itemized bill to verify that all services were rendered and that no unbundled codes or duplicate charges were included. Disputing errors in writing is the most effective way to reduce medical debt, as over 80% of hospital bills contain inaccuracies that can be corrected.