Blood transfusion
Facility: Mitchell County Hospital Health Systems
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $672
- Cash Discount Price: $672
- vs. Medicare Baseline: 1.49x 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 |
|---|---|---|
| UnitedHealthcare | $451 - $747 | 100% |
| Blue Cross Blue Shield | $516 | 114% |
| Triwest Well Mark All Plans | $635 | 141% |
| Auxiant-All Plans | $665 | 148% |
| Pref Hlth Care Sytms Comm - All Plans | $672 | 149% |
| Aetna | $672 | 149% |
| First Health-All Plans | $672 | 149% |
| Phc Leased Ntwrk Access - All Plans | $710 | 158% |
| Multiplan Ppo - All Plans | $710 | 158% |
| Health Partners Ks-All Plans | $740 | 164% |
| Cigna | $740 | 164% |
Consumer Guidance & Cost Commentary
For the CPT code 36430, representing a blood transfusion, the gross charge at Mitchell County Hospital Health Systems is $747.00. While the facility's cash median and median negotiated rates are both $672.00, these figures are notably higher than the Medicare benchmark of $450.73, indicating a markup of 1.5 times the federal rate. It is important to note that commercial insurance plans, such as UnitedHealthcare and Blue Cross Blue Shield, have negotiated rates ranging from $451 to $747, which often exceed the cash price. Patients with high-deductible plans may find that paying the cash rate of $672.00 upfront is more cost-effective than relying on insurance, which could result in a higher allowed amount before the deductible is met.
To minimize costs, patients should proactively request a "self-pay" or "prompt-pay" discount before scheduling services, as hospitals often offer fee reductions of 20% to 50% for upfront payment to bypass administrative claim processing. Additionally, while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, it is crucial to verify that all ancillary services, such as laboratory tests or emergency physician care, are covered under the facility's network agreements. Before finalizing payment, consumers should demand a full itemized bill to review specific CPT codes and ensure no unbundled charges or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a formal written audit dispute.