Blood transfusion
Facility: Stevens County Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $560
- Cash Discount Price: $644
- vs. Medicare Baseline: 1.24x 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 |
|---|---|---|
| Humana | $238 | 53% |
| Aetna | $245 - $644 | 54% |
| Blue Cross Blue Shield | $490 - $516 | 109% |
| First Health - All Plans | $580 | 129% |
| Wppa - All Plans | $612 | 136% |
| Medicaid / KanCare | $644 | 143% |
Consumer Guidance & Cost Commentary
For the CPT code 36430, representing a blood transfusion at Stevens County Hospital in Hugoton, Kansas, the facility's cash median rate is $644.00, which matches the gross charge and the highest negotiated rate among payers. While the facility is a Critical Access Hospital with a government-local ownership structure, patients should be aware that cash payments can sometimes be more cost-effective than using insurance if the patient's deductible has not yet been met. In this specific case, the cash price aligns with the maximum negotiated amount of $644.00, meaning there is no financial advantage to paying out-of-pocket for this specific service compared to the highest commercial rates. However, patients are encouraged to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which could potentially reduce the final bill if paid upfront before the insurance claim is processed.
When evaluating the cost of this procedure, it is important to compare rates against the Medicare benchmark rather than the hospital's gross chargemaster list. The Medicare amount for this service is $450.73, and the facility's cash rate of $644.00 represents a markup of 1.2 times the Medicare rate. This aligns with the typical range where fair pricing is often defined as 120% to 150% of the Medicare benchmark, whereas commercial negotiated rates can average significantly higher. Since the facility is located in a rural area (Zip 67951), local wage indexes may influence these rates, but the data indicates that the negotiated rates for major payers like Aetna and Blue Cross Blue Shield range from $238 to