Blood transfusion
Facility: Mcpherson Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $1,192
- Cash Discount Price: $1,020
- vs. Medicare Baseline: 2.64x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 264% of the Medicare baseline (a markup of 164%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Tricare | $357 | 79% |
| Wellcare Mcr Adv - All Plans | $406 | 90% |
| Healthy Blue Mcr Adv | $406 | 90% |
| UnitedHealthcare | $406 - $1,771 | 90% |
| Humana | $406 | 90% |
| Blue Cross Blue Shield | $406 | 90% |
| Va Ccn - All Plans | $406 | 90% |
| Ambetter / Centene | $467 | 104% |
| Wppa - All Plans | $800 - $1,240 | 177% |
| Medical Associates - All Plans | $857 - $1,328 | 190% |
| Central Plains - All Plans | $857 - $1,328 | 190% |
| Christian Health Aid - All Plans | $914 - $1,417 | 203% |
| Aetna | $943 - $1,771 | 209% |
| Multiplan - All Plans | $1,029 - $1,594 | 228% |
| First Health - All Plans | $1,086 - $1,682 | 241% |
| Health Partners - All Plans | $1,086 - $1,682 | 241% |
| Cigna | $1,086 - $1,682 | 241% |
| Medicaid / KanCare | $1,143 - $1,771 | 254% |
| Health Blue Mcaid - All Other Plans | $1,166 - $1,806 | 259% |
Consumer Guidance & Cost Commentary
For the CPT code 36430 (Blood transfusion) at McPherson Hospital in McPherson, KS, the facility's cash median rate of $1,020.00 is notably lower than the gross charge of $1,379.00, offering a potential savings for patients who can pay directly. While the hospital's negotiated rates with major payers like UnitedHealthcare and Aetna range from $406 to $1,771, these amounts often exceed the cash price due to administrative overhead and contract structures. It is important to note that while commercial negotiated rates typically average 200% to 300% of the Medicare benchmark of $450.73, fair pricing is generally defined as 120% to 150% of this rate. Patients with high-deductible plans may find that paying the cash median of $1,020.00 upfront is more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if the deductible is not yet met or if the negotiated rate exceeds the cash price.
Before scheduling any services, consumers should proactively request a "self-pay" or "prompt-pay" discount, which can reduce the final bill by 20% to 50% by bypassing costly claims processing and administrative fees. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to verify that all ancillary services, such as laboratory tests or specific physician components, are also covered under the facility's network agreements. To ensure accuracy, patients should demand a full itemized billing audit