Blood transfusion
Facility: Trego County Lemke Memorial Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $515
- Cash Discount Price: $640
- vs. Medicare Baseline: 1.14x 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 | $57 - $507 | 13% |
| Tricare | $62 - $548 | 14% |
| Va Ccn - All Plans | $73 - $642 | 16% |
| Aetna | $73 - $932 | 16% |
| UnitedHealthcare | $73 - $1,035 | 16% |
| Medicaid / KanCare | $73 - $1,035 | 16% |
| Ambetter / Centene | $80 - $706 | 18% |
| Health Partners - All Plans | $111 - $983 | 25% |
| Healthy Blue Mcaid - All Plans | $117 - $1,035 | 26% |
| Blue Cross Blue Shield | $705 | 156% |
Consumer Guidance & Cost Commentary
For the CPT code 36430, representing a blood transfusion, the facility's cash median price of $640 is lower than the gross charge of $753, offering a potential savings for patients with high-deductible plans or those without insurance. While the facility's negotiated rates range from $57 to $1,035 depending on the payer, these amounts often exceed the cash price due to administrative overhead and contract structures. It is important to note that commercial negotiated rates frequently average 200% to 300% of the Medicare benchmark rate of $450.73, whereas fair pricing is typically defined as 120% to 150% of this baseline. Patients should verify their specific plan's negotiated rate before scheduling, as in-network contracts can vary significantly, and should consider paying cash upfront to avoid higher insurance-driven costs.
To minimize unexpected costs, patients should proactively request a "self-pay" or "prompt-pay" discount, which can reduce bills by 20% to 50% by bypassing costly claims processing and administrative fees. Since over 80% of hospital bills contain errors, it is advisable to request a full itemized billing audit rather than accepting a summary invoice, ensuring no unbundled codes or services not rendered are included. Additionally, while the No Surprises Act protects patients from balance billing for emergency care and non-emergency services at in-network facilities, patients should still review their itemized statement carefully. For this procedure at Trego County Lemke Memorial Hospital, the Medicare benchmark serves as the objective baseline for evaluating any markup, providing a scientifically validated standard to compare against the facility's commercial