Blood transfusion
Facility: Holton Community Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $900
- Cash Discount Price: $919
- vs. Medicare Baseline: 2.00x 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 |
|---|---|---|
| Aetna | $477 - $1,344 | 106% |
| UnitedHealthcare | $477 - $1,344 | 106% |
| Humana | $482 - $719 | 107% |
| Kansas Superior Select - All Plans | $487 - $727 | 108% |
| Preferred Health Fn Select - All Other Plans | $747 - $1,116 | 166% |
| Preferred Health Freedom | $747 - $1,116 | 166% |
| Preferred Health Professionals | $747 - $1,116 | 166% |
| Wppa Providers - All Plans | $855 - $1,277 | 190% |
| Medicaid / KanCare | $900 - $1,344 | 200% |
Consumer Guidance & Cost Commentary
For this blood transfusion service at Holton Community Hospital, the negotiated rates paid by insurance carriers range from $477 to $1,344, with the highest amounts seen by Aetna and UnitedHealthcare. While these in-network rates are significantly higher than the facility's cash price of $919, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance allowed amount exceeds the cash rate. It is important to note that the facility's cash price is also lower than the state average for this procedure, making direct payment a potentially cost-effective option for those without insurance or with limited coverage.
To minimize costs, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. Additionally, because the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should not pay surprise bills immediately upon receiving them. Instead, they should request a full itemized CPT-coded bill to verify all charges and dispute any errors in writing, ensuring they are only billed for services actually rendered and at the correct negotiated or cash rates.