Blood transfusion
Facility: Decatur Health
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $773
- Cash Discount Price: $838
- vs. Medicare Baseline: 1.71x 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $559 - $656 | 124% |
| UnitedHealthcare | $568 - $835 | 126% |
| Humana | $574 - $674 | 127% |
| Blue Cross Blue Shield | $664 | 147% |
| Aetna | $838 - $1,094 | 186% |
| Midlands Choice- All Plans | $838 - $984 | 186% |
| Medicaid / KanCare | $941 - $1,105 | 209% |
Consumer Guidance & Cost Commentary
For the Blood transfusion procedure (CPT 36430) at Decatur Health in Oberlin, KS, the cash median price is $838.00, which is lower than the facility's gross charge of $931.00. While the facility's negotiated rates with major payers like UnitedHealthcare and Aetna range from $568 to $1,094, the cash price can be a more cost-effective option for patients with high-deductible plans or those without insurance, as it avoids the administrative markup inherent in insurance billing. It is important to note that commercial negotiated rates often exceed cash prices due to the costs of claims processing and contract management, meaning paying out-of-pocket upfront may result in a lower total out-of-pocket cost compared to what an insurer would allow.
To ensure you are receiving the best possible rate, you should actively request a "prompt-pay" discount or self-pay classification before scheduling your visit, as hospitals often offer significant fee reductions for upfront payment to bypass costly insurance billing cycles. Additionally, if you have insurance, be aware that balance billing could occur if you receive care from out-of-network providers, though the No Surprises Act protects you from such surprise bills for emergency services at in-network facilities. Since over 80% of hospital bills contain errors, always demand a full itemized CPT-coded bill rather than accepting a summary invoice, and consider disputing any charges that appear unbundled or for services not rendered to avoid unnecessary medical debt.