Blood transfusion
Facility: Phillips County Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $485
- Cash Discount Price: $412
- vs. Medicare Baseline: 1.08x 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 |
|---|---|---|
| UnitedHealthcare | $40 - $988 | 9% |
| Blue Cross Blue Shield | $40 - $800 | 9% |
| Medicaid / KanCare | $50 - $988 | 11% |
| Health Partners-All Plans | $50 - $988 | 11% |
Consumer Guidance & Cost Commentary
For the CPT code 36430 (Blood transfusion) at Phillips County Hospital in Phillipsburg, KS, the cash price is $412.00, which is lower than the facility's negotiated rate of $485.00. This cash price is also lower than the state average for this procedure. While commercial payers like UnitedHealthcare and Blue Cross Blue Shield have negotiated rates ranging from $40 to $988, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance negotiated rate exceeds $412.00. To maximize savings, patients should verify their specific plan's allowed amount before scheduling and ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill.
The Medicare benchmark for this service is $450.73, which serves as a reliable baseline for evaluating pricing fairness. The facility's cash rate of $412.00 is below the Medicare amount, indicating a competitive price point compared to the federal standard. However, patients should be aware that commercial insurance often results in higher out-of-pocket costs due to administrative overhead and contract dynamics, even when the facility is in-network. If a patient receives an itemized bill that includes unexpected charges or broad category summaries, they should request a full line-by-line audit to identify errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain mistakes that can be corrected through formal written disputes.