Blood transfusion
Facility: Clay County Medical Center
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $698
- Cash Discount Price: $743
- vs. Medicare Baseline: 1.55x 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 | $573 - $810 | 127% |
| Aetna | $573 - $810 | 127% |
| Multiplan- All Plans | $585 - $827 | 130% |
| UnitedHealthcare | $585 - $827 | 130% |
| Health Partners - All Plans | $585 - $827 | 130% |
Consumer Guidance & Cost Commentary
For this blood transfusion service at Clay County Medical Center in Clay Center, KS, the cash price is $743.00, which matches the facility's median paid amount. While the facility is a Critical Access Hospital with government-local ownership, the negotiated rates for major payers like Aetna, UnitedHealthcare, and Multiplan range from $573 to $827, with a median negotiated amount of $698.00. This indicates that for patients with high-deductible plans, paying cash directly might be more cost-effective than using insurance, as the cash price is lower than the average negotiated rate. However, patients should verify their specific plan's deductible status and ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
It is important to understand that commercial insurance rates often exceed the true cost of care, which is best measured against the Medicare benchmark of $450.73. In this case, the cash price is 1.5 times the Medicare rate, reflecting the administrative costs and profit margins built into commercial billing. If you receive a bill from an out-of-network provider or encounter unexpected charges, you may be subject to balance billing, where the provider charges the difference between their full rate and what your insurance allowed. To protect yourself, always request a full itemized bill to check for errors, such as unbundled codes or services not rendered, and dispute any surprise charges in writing rather than accepting summary invoices or signing away your rights to contest out-of-network fees.