Blood transfusion
Facility: Hamilton County Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $149
- Cash Discount Price: $148
- vs. Medicare Baseline: 0.33x 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 |
|---|---|---|
| First Health Coventry - All Plans | $122 - $130 | 27% |
| Cigna | $137 - $145 | 30% |
| UnitedHealthcare | $137 - $145 | 30% |
| Va Ccn - All Plans | $152 | 34% |
| Blue Cross Blue Shield | $243 - $516 | 54% |
| Aetna | $259 - $366 | 57% |
Consumer Guidance & Cost Commentary
For the CPT code 36430, representing a blood transfusion, Hamilton County Hospital in Syracuse, KS, lists a cash median price of $148.00. This cash rate is notably lower than the facility's negotiated rates, which range from $122 to $516 depending on the insurance carrier, with Blue Cross Blue Shield showing the highest variance. The facility's cash price is also significantly lower than the Medicare benchmark of $450.73, which serves as the federal baseline for healthcare costs. While commercial insurance plans like First Health Coventry and Cigna have negotiated rates between $122 and $145, patients with high-deductible plans may find paying the cash price of $148.00 more cost-effective if their insurance allowed amount exceeds this figure, as the administrative overhead often inflates the final bill.
Patients should be aware that while the facility is a Critical Access Hospital with government local ownership, the specific negotiated rates vary widely across the six payers listed, with UnitedHealthcare and Aetna showing ranges up to $366. To minimize costs, it is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% for upfront payment. Additionally, since over 80% of hospital bills contain errors, consumers are encouraged to request a detailed, itemized billing audit rather than accepting a summary invoice. By comparing the facility's cash rate against the Medicare benchmark and verifying the specific allowed amount for their plan, patients can make informed decisions that avoid unexpected balance billing and ensure they are paying a fair price for