Blood transfusion
Facility: Kansas City Orthopaedic Institute
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $1,002
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.22x 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 222% of the Medicare baseline (a markup of 122%). 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 |
|---|---|---|
| UnitedHealthcare | $385 | 85% |
| Aetna | $385 | 85% |
| Cigna | $411 | 91% |
| Blue Cross Blue Shield | $1,002 | 222% |
Consumer Guidance & Cost Commentary
For the CPT code 36430 (Blood transfusion) at Kansas City Orthopaedic Institute in Leawood, KS, the negotiated rates vary significantly by insurer, ranging from $385 with UnitedHealthcare and Aetna to $1,002 with Blue Cross Blue Shield. These commercial rates are notably higher than the Medicare benchmark of $450.73, reflecting the administrative costs and contract structures that commercial payers utilize. While the facility is a physician-owned acute care hospital, the data indicates no specific cash or median paid amounts were reported for this service, meaning patients without insurance coverage should verify current self-pay or prompt-pay discounts directly with the billing department before scheduling.
It is important to note that commercial negotiated rates often exceed cash prices due to the administrative overhead and multi-layered billing processes inherent in insurance contracts. For patients with high-deductible plans, paying the cash price upfront could sometimes be more cost-effective than relying on insurance, provided the facility offers a prompt-pay discount that brings the total cost below the insurer's allowed amount. Additionally, under federal protections like the No Surprises Act, patients at this in-network facility are shielded from balance billing by out-of-network providers for emergency or non-emergency services, though they should still request an itemized bill to ensure all charges are accurate and bundled correctly.