Blood transfusion
Facility: Osborne County Memorial Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $945
- Cash Discount Price: $900
- vs. Medicare Baseline: 2.10x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 210% of the Medicare baseline (a markup of 110%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $190 - $1,029 | 42% |
| Health Partners Of Kansas | $215 - $1,164 | 48% |
| Wppa | $238 - $1,286 | 53% |
| Blue Cross Blue Shield | $245 - $1,327 | 54% |
Consumer Guidance & Cost Commentary
For the CPT code 36430, representing a blood transfusion at Osborne County Memorial Hospital in Osborne, KS, the facility's cash median rate is $900.00, which is notably lower than the gross charge of $1,058.00. While the hospital's negotiated rates for in-network payers like UnitedHealthcare and Blue Cross Blue Shield range from $215 to $1,327, these amounts often exceed the cash price due to administrative overhead and contract structures. For patients with high-deductible plans, paying the cash median of $900.00 upfront can be more cost-effective than relying on insurance, which may result in higher out-of-pocket costs if the deductible has not yet been met. It is advisable to contact the hospital directly to confirm "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing the standard insurance billing cycle.
When evaluating the cost of this service, it is important to compare the facility's pricing against the Medicare benchmark, which stands at $450.73 for this procedure. The facility's cash rate of $900.00 represents a 2.1x markup compared to the Medicare amount, reflecting the typical range where commercial rates exceed federal reimbursement. Although specific county or state average data was not provided in the available information, patients should be aware that commercial negotiated rates frequently include a 20% to 40% administrative load and can sometimes reach 200% to 300% of the Medicare baseline. To ensure transparency, consumers should request an itemized bill to verify that no services were unbundled or