Blood transfusion
Facility: Scott County Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $1,128
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.50x 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 250% of the Medicare baseline (a markup of 150%). 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 | $257 - $1,190 | 57% |
| Blue Cross Blue Shield | $516 | 114% |
| Humana | $526 | 117% |
| Wppa | $752 - $1,200 | 167% |
| Aetna | $1,128 | 250% |
Consumer Guidance & Cost Commentary
For the CPT code 36430 (Blood transfusion) at Scott County Hospital in Scott City, KS, the Medicare benchmark rate is $450.73. This federal baseline serves as the objective standard for evaluating pricing markups, as commercial negotiated rates often range from 200% to 300% of this amount. While the facility's median negotiated rate is $1,128.00, commercial payers like UnitedHealthcare and Wppa have reported ranges extending up to $1,200, which aligns with the typical commercial markup seen in the region. It is important to note that the facility's cash median and median paid values are not available in the current data, but patients should be aware that cash-pay options can sometimes result in lower out-of-pocket costs if the insurance negotiated rate exceeds the cash price.
Patients should proactively contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid in full upfront. Since administrative processing costs and claim denials inflate insurance rates, paying directly can bypass these fees and potentially lower the total cost. Additionally, because the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should verify that all services are covered under their plan before scheduling. If a surprise bill does occur, consumers should request a formal itemized audit to identify errors or unbundled charges, as over 80% of hospital bills contain discrepancies that can be resolved through written dispute.