Blood transfusion
Facility: Hiawatha Community Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $868
- Cash Discount Price: $1,446
- vs. Medicare Baseline: 1.93x 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 | $334 - $1,168 | 74% |
| UnitedHealthcare | $334 - $1,242 | 74% |
| Humana | $338 - $540 | 75% |
| Ambetter / Centene | $401 - $642 | 89% |
| Blue Cross Blue Shield | $490 - $516 | 109% |
| Oscar - All Plans | $678 - $1,084 | 150% |
| Centrus Health Direct - All Plans | $678 - $1,084 | 150% |
| Preferred Hlth - All Plans | $814 - $1,301 | 181% |
| Cigna | $859 - $1,374 | 191% |
| Wppa Providrs Care - All Plans | $859 - $1,374 | 191% |
| Midlands Choice - All Plans | $877 - $1,403 | 195% |
| Multiplan - All Plans | $877 - $1,403 | 195% |
| Healthy Blue Mcaid - All Plans | $904 - $1,446 | 201% |
Consumer Guidance & Cost Commentary
For the CPT code 36430 (Blood transfusion) at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $1,446.00, which matches the facility's median paid amount. This cash rate is significantly higher than the state average, as the facility's negotiated rate of $868.00 is lower than the median negotiated rate of $859.00 reported for the region. While commercial payers like Aetna and UnitedHealthcare have negotiated rates ranging from $334 to $1,242, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket if their insurance allowed amount surpasses the cash rate. It is important to note that while the facility is a Critical Access Hospital with a voluntary non-profit ownership, patients should verify their specific plan's allowed amount before scheduling, as in-network rates vary widely among the 13 payers listed.
Patients should be aware that balance billing can occur if a provider bills the difference between the chargemaster and the insurance allowed amount, though the No Surprises Act protects against this for emergency care and non-emergency services at in-network facilities. To avoid unexpected costs, consumers should request a full itemized billing audit before paying, as summary bills often obscure individual charges or unbundled services that should be included in a single code. Additionally, asking for a prompt-pay discount upfront can reduce the total cost, as hospitals offer immediate discounts to patients who pay in full rather than waiting for insurance reimbursement. Given the facility's location in Kansas and its status as a Critical Access Hospital, comparing the $1,