Blood transfusion
Facility: Wesley Medical Center
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $584
- Cash Discount Price: $2,455
- vs. Medicare Baseline: 1.30x 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 |
|---|---|---|
| UnitedHealthcare | $257 | 57% |
| Medicaid / KanCare | $265 | 59% |
| Aetna | $268 - $1,897 | 59% |
| Amerigroup | $268 | 59% |
| United | $371 - $1,661 | 82% |
| Health Partners Of Kansas | $425 - $1,228 | 94% |
| Wppa | $427 | 95% |
| Ambetter / Centene | $442 | 98% |
| Preferred Health Choices | $464 | 103% |
| Medical Associates Health Plan | $464 | 103% |
| Blue Cross Blue Shield | $497 | 110% |
| First Health | $713 - $1,132 | 158% |
| Multiplan | $743 - $2,210 | 165% |
| Spirit Aerosystems | $786 | 174% |
| Usa Managed Care | $2,087 | 463% |
Consumer Guidance & Cost Commentary
For the CPT code 36430 (Blood transfusion) at Wesley Medical Center in Wichita, KS, the cash price is $2,455.00, which matches the facility's cash median. This rate is significantly higher than the state average, as indicated by a ratio of 1.3 times the Medicare benchmark of $450.73. While commercial insurance plans like Aetna and Multiplan have negotiated rates ranging from $268 to $2,210, these amounts often exceed the cash price for patients with high-deductible plans. In such cases, paying the cash rate directly can be more cost-effective than relying on insurance, provided the patient has not yet met their deductible. Patients are encouraged to verify their specific plan's allowed amount and ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling services to ensure they are not overpaying due to administrative fees or network tiering.
It is important to understand that commercial negotiated rates are often inflated by administrative costs and contract dynamics, sometimes reaching 200% to 300% of the Medicare benchmark, whereas fair pricing is typically defined between 120% and 150% of that baseline. The facility's cash rate of $2,455.00 represents a substantial markup over the Medicare amount, highlighting the potential for significant savings through direct payment or prompt-pay arrangements. Consumers should avoid accepting summary bills that obscure individual charges and instead request a full itemized audit to identify any unbundled codes or services not rendered. Furthermore, if a patient receives care from an out-of-network provider at this facility, they may be subject to balance