Blood transfusion
Facility: Rooks County Health Center
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $771
- Cash Discount Price: $642
- vs. Medicare Baseline: 1.71x 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 |
|---|---|---|
| Veterans Admin - All Plans | $367 - $803 | 81% |
| Tricare | $367 - $803 | 81% |
| Celtic Mcr Adv | $367 - $803 | 81% |
| Celtic Comm - All Other Plans | $404 - $884 | 90% |
| Blue Cross Blue Shield | $516 | 114% |
| Aetna | $703 - $1,538 | 156% |
| Preferred Benefits Admin | $703 - $1,538 | 156% |
| UnitedHealthcare | $703 - $1,538 | 156% |
| Preferred Hlthcare - All Other Plans | $742 - $1,624 | 165% |
| Health Partners - All Plans | $742 - $1,624 | 165% |
| Healthy Blue Mcaid - All Plans | $782 - $1,709 | 173% |
Consumer Guidance & Cost Commentary
For the CPT code 36430 (Blood transfusion) at Rooks County Health Center in Plainville, KS, the facility's cash median rate is $642.00, which is lower than the state average of $760.00 and the median negotiated rate of $771.00. While commercial payers like Aetna and UnitedHealthcare negotiate rates ranging from $703 to $1,538, patients with high-deductible plans may find paying the cash price of $642.00 more cost-effective if their insurance allowed amount exceeds this figure. It is important to note that the facility, a Critical Access Hospital owned by a Government Hospital District, does not list a specific facility rating, and patients should verify "self-pay" or "prompt-pay" discounts directly with the hospital before scheduling to potentially reduce costs further.
The Medicare benchmark for this service is $450.73, which serves as a baseline for evaluating the facility's pricing markup. The facility's gross charge of $857.00 is significantly higher than the Medicare rate, illustrating how commercial negotiated rates often exceed the true cost of care. Under the No Surprises Act, patients are protected from balance billing for out-of-network services at in-network facilities, though they should still request an itemized bill to ensure no unbundled codes or services not rendered are included. If a patient receives a bill exceeding the negotiated or cash rates, they should dispute it in writing with the billing supervisor rather than accepting a summary invoice, as over 80% of hospital bills contain errors that can be corrected through a formal audit.