Blood transfusion
Facility: Lmh
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $782
- Cash Discount Price: $581
- vs. Medicare Baseline: 1.73x 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 |
|---|---|---|
| Blue Cross Blue Shield | $260 - $1,548 | 58% |
| UnitedHealthcare | $260 - $1,658 | 58% |
| Medicare (plans) | $444 | 99% |
| Haskell Indian Health Services | $444 | 99% |
| Cigna | $444 - $1,598 | 99% |
| Humana | $444 | 99% |
| Allwell | $453 | 101% |
| Ambetter / Centene | $689 | 153% |
| Aetna | $1,438 - $1,986 | 319% |
| Non Contracted | $1,806 - $1,914 | 401% |
| First Health | $2,099 - $2,225 | 466% |
Consumer Guidance & Cost Commentary
For patients paying cash directly, the most important factor to know upfront is that this specific procedure carries a median cash price of $581, which is significantly lower than the facility's gross chargemaster rate of $2,325. While commercial insurance plans often negotiate higher rates due to administrative costs and contract structures, the self-pay option can be the most cost-effective choice for those with high-deductible plans or those who have already met their out-of-pocket limits. It is crucial to contact the hospital directly before scheduling to confirm availability of "self-pay" or "prompt-pay" discounts, as these upfront fee reductions can further lower the final amount owed by bypassing the standard insurance billing cycle.
The broader financial context shows that while the cash rate of $581 is the baseline, the facility's negotiated rates vary widely depending on the payer, ranging from a low of $260 for some plans to as high as $1,986 for others. For instance, UnitedHealthcare and Blue Cross Blue Shield have negotiated ranges starting at $260, whereas Aetna's range extends up to $1,986. Because commercial rates often include multi-layered administrative structures, the cash price serves as a vital benchmark for transparency, allowing patients to compare the actual cost against the facility's listed charges and understand the potential savings of paying out-of-network or self-pay.