Blood transfusion
Facility: Kiowa District Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $179
- Cash Discount Price: $138
- vs. Medicare Baseline: 0.40x 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 |
|---|---|---|
| Tricare | $16 - $183 | 4% |
| UnitedHealthcare | $32 - $469 | 7% |
| Health Partners Of Ks-All Plans | $35 - $413 | 8% |
| Humana | $36 - $423 | 8% |
| Medicare (plans) | $38 - $446 | 8% |
| Multiplan-All Plans | $38 - $441 | 8% |
| Gbs Insurance - All Plans | $38 - $441 | 8% |
| Triwest-All Plans | $38 - $446 | 8% |
| Aetna | $38 - $446 | 8% |
| Medicaid / KanCare | $40 - $469 | 9% |
| Providers Care (Wppa)-All Plans | $60 - $704 | 13% |
| Liberty Healthshare-All Plans | $65 - $757 | 14% |
| Blue Cross Blue Shield | $511 | 113% |
| Healthchoice-All Plans | $660 | 146% |
Consumer Guidance & Cost Commentary
For the CPT code 36430 (Blood transfusion) at Kiowa District Hospital in Kiowa, KS, the facility's cash median price is $138.00, which is notably lower than the state average of $179.00. While the hospital's gross charge is $173.00, commercial insurance plans negotiate rates that often exceed the cash price; for instance, UnitedHealthcare and Medicaid/KanCare have negotiated ranges starting at $32 and $40 respectively, with some plans reaching up to $757. This pricing structure highlights a common billing scenario where paying cash upfront can be more cost-effective than relying on insurance, particularly for patients with high-deductible plans where the negotiated allowed amount might surpass the cash rate.
Patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling services to secure the lowest possible rate, as these upfront payment incentives can bypass administrative fees and reduce the final bill significantly. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, unexpected charges can still occur if ancillary services are not covered under the plan. To ensure transparency, consumers should always demand a full, itemized bill before paying and verify that no unnecessary services or unbundled codes are included in the final statement.