Blood transfusion
Facility: Nemaha Valley Community Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $478
- Cash Discount Price: $761
- vs. Medicare Baseline: 1.06x 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 |
|---|---|---|
| Va Ccn - All Plans | $372 | 83% |
| Humana | $372 | 83% |
| Aetna | $376 - $719 | 83% |
| Celtic Comm Exch - All Plans | $409 | 91% |
| Partners Direct Health - All Plans | $440 | 98% |
| Blue Cross Blue Shield | $516 | 114% |
| Multiplan - All Plans | $761 | 169% |
| Health Partners - All Plans | $804 | 178% |
| Midlands Choice - All Plans | $804 | 178% |
Consumer Guidance & Cost Commentary
For the Blood transfusion procedure (CPT 36430) at Nemaha Valley Community Hospital in Seneca, KS, the cash price is $761.00, which is significantly lower than the facility's gross charge of $846.00. While the hospital's negotiated rates for in-network payers range from $372 to $804, the cash price is notably lower than the median negotiated rate of $478.00. This suggests that for patients with high-deductible plans or those without insurance, paying cash upfront may be the most cost-effective option, potentially saving hundreds of dollars compared to standard insurance billing. Patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as hospitals often offer additional reductions for upfront payment that are not automatically applied to insurance claims.
It is important to note that the facility's cash price of $761.00 is higher than the state of Kansas average for this service, which is reflected in the Medicare benchmark of $450.73 and the facility's 1.1x markup relative to Medicare. Because the cash price exceeds the Medicare amount, patients should carefully review their specific insurance allowed amounts, as some commercial payers may negotiate rates lower than the cash price. To avoid unexpected costs, consumers should demand a full itemized bill before paying and verify that no out-of-network ancillary services are being billed, which could trigger balance billing protections under the No Surprises Act. Always confirm the final cost with the hospital's billing department to ensure all discounts and potential errors are accounted for.