Blood transfusion
Facility: Ellsworth County Medical Center
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $793
- Cash Discount Price: $1,002
- vs. Medicare Baseline: 1.76x 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 |
|---|---|---|
| Healthy Blue Mcr Adv | $118 - $854 | 26% |
| Humana | $118 - $1,727 | 26% |
| Triwest -All Plans | $118 - $854 | 26% |
| Va Ccn-All Plans | $118 - $854 | 26% |
| UnitedHealthcare | $162 - $1,818 | 36% |
| Aetna | $225 - $1,636 | 50% |
| First Health - All Plans | $225 - $1,636 | 50% |
| Cigna | $238 - $1,727 | 53% |
| Healthy Blue Mcaid- All Other Plans | $250 - $1,818 | 55% |
| Medicaid / KanCare | $250 - $1,818 | 55% |
| Coventry Mcaid-All Plans | $250 - $1,818 | 55% |
| Providers Care-Wppa-All Plans | $375 - $2,727 | 83% |
| Blue Cross Blue Shield | $485 - $511 | 108% |
Consumer Guidance & Cost Commentary
For this blood transfusion service at Ellsworth County Medical Center, the cash price is $1,002, which matches the facility's median paid amount. While commercial insurance plans like Healthy Blue Mcr Adv and Triwest -All Plans negotiate rates as low as $118, other major payers such as UnitedHealthcare and Providers Care-Wppa-All Plans have negotiated rates ranging up to $2,727. It is important to note that cash payments can sometimes be more cost-effective for patients with high-deductible plans if their insurance negotiated rate exceeds the cash price. Additionally, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, as paying upfront can often reduce the final bill by 20% to 50% by bypassing administrative claim processing costs.
The facility's cash rate of $1,002 is significantly higher than the Medicare benchmark of $450.73, indicating a markup of 1.8 times the federal rate. This aligns with the general industry trend where commercial negotiated rates often average 200% to 300% of Medicare, though fair pricing is typically defined as 120% to 150% of the Medicare amount. Given that over 80% of hospital bills contain errors, patients should request a detailed, itemized CPT-coded bill rather than accepting a summary invoice to identify any unbundled codes or services not rendered. If a balance bill arises from an out-of-network provider, patients should not pay immediately out of fear of credit damage but instead dispute the charge with their insurer to request a No Surprises Act audit.