Blood transfusion
Facility: Ashland Health Center
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $720
- Cash Discount Price: $576
- vs. Medicare Baseline: 1.60x 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 | $241 | 53% |
| Compalliance-All Plans | $576 | 128% |
| Health Partners Of Kansas-All Plans | $612 | 136% |
| Multiplan-All Plans | $706 | 157% |
| Healthy Blue Mcr Adv - All Other Plans | $720 | 160% |
| Aetna | $720 | 160% |
| Health Choice-All Plans | $720 | 160% |
| Medica Mcare - All Plans | $720 | 160% |
| Medicare (plans) | $720 | 160% |
| UnitedHealthcare | $720 | 160% |
| Medicaid / KanCare | $720 | 160% |
| Providers Care (Wppa)-All Plans | $1,080 | 240% |
Consumer Guidance & Cost Commentary
For the CPT code 36430 (Blood transfusion) at Ashland Health Center in Ashland, KS, the facility's negotiated rates range from $241 to $720 depending on the insurance plan, with a median paid amount of $720.00. This aligns with the facility's cash median price of $576.00 and its median negotiated rate of $720.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should note that cash payments are often lower than insurance negotiated rates; however, for those with high-deductible plans, paying the full cash price of $576.00 upfront may result in lower out-of-pocket costs compared to having insurance cover the higher negotiated amount of $720.00, especially if the patient has not yet met their deductible.
It is important to distinguish between the facility's negotiated rates and the Medicare benchmark, which stands at $450.73 for this procedure. The facility's median negotiated rate of $720.00 represents a 1.6x markup relative to the Medicare amount, which is consistent with typical commercial pricing structures where rates average 200% to 300% of Medicare. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, they should still request an itemized bill to verify that no unbundled codes or services not rendered are included. Additionally, patients should proactively ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 2