Blood transfusion
Facility: Community Memorial Healthcare, Inc.
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $454
- Cash Discount Price: $778
- vs. Medicare Baseline: 1.01x 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 | $267 - $741 | 59% |
| UnitedHealthcare | $332 - $530 | 74% |
| Blue Cross Blue Shield | $516 | 114% |
Consumer Guidance & Cost Commentary
For the CPT code 36430 (Blood transfusion) at Community Memorial Healthcare, Inc. in Marysville, KS, the facility's cash median rate is $778.00, which matches the gross charge and the Medicare benchmark of $450.73. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. In this specific case, the median negotiated amount across payers is $454.00, which is slightly higher than the cash price, illustrating that paying out-of-pocket can sometimes result in lower costs than using insurance for this service.
When comparing pricing to regional standards, the facility's cash rate of $778.00 aligns directly with the Medicare benchmark, avoiding the common pitfall of comparing discounts to inflated chargemaster lists. For patients with high-deductible plans, this alignment suggests that paying the cash price or a potential prompt-pay discount may be more financially advantageous than relying on insurance, which could trigger higher negotiated rates or deductibles. It is important to verify your specific plan's deductible status and ask the hospital directly about self-pay or prompt-pay discounts before scheduling, as these upfront incentives can significantly reduce the final amount owed.