Blood transfusion
Facility: Girard Medical Center
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $608
- Cash Discount Price: $923
- vs. Medicare Baseline: 1.35x 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 |
|---|---|---|
| Medicare (plans) | $469 - $608 | 104% |
| Aetna | $469 - $3,040 | 104% |
| Ambetter / Centene | $469 - $608 | 104% |
| Kansas Superior Select-All Plans | $469 - $608 | 104% |
| Humana | $469 - $608 | 104% |
| Blue Cross Blue Shield | $469 - $608 | 104% |
| UnitedHealthcare | $469 - $1,650 | 104% |
| Multiplan-All Plans | $1,239 - $1,607 | 275% |
| Uhhis-All Plans | $1,272 - $1,650 | 282% |
Consumer Guidance & Cost Commentary
For the CPT code 36430 (Blood transfusion) at Girard Medical Center in Girard, KS, the facility's cash median price is $923.00, which is notably higher than the state average of $523.00. While Medicare sets a benchmark of $450.73, commercial insurance plans negotiate rates that vary significantly; for example, Aetna and UnitedHealthcare have negotiated ranges extending up to $1,650, whereas Medicare and several other plans cap payments at $608. Patients should be aware that while in-network insurance often provides a ceiling on costs, the negotiated rates can sometimes exceed the cash price, making self-pay options potentially more affordable for those with high-deductible plans who may not meet their annual out-of-pocket thresholds.
To secure the most favorable rate, it is essential to verify the specific "self-pay" or "prompt-pay" discounts offered by the hospital before scheduling, as these upfront payment incentives can bypass administrative fees and reduce the final bill. Although the facility is a Critical Access Hospital owned by a Government Hospital District, commercial payers like Aetna and UnitedHealthcare have negotiated rates that are substantially higher than the facility's cash median, illustrating how administrative structures and contract dynamics can inflate the baseline price. Consumers are advised to request an itemized billing audit if they receive a summary bill, ensuring that no unbundled codes or services not rendered are included, and to compare all allowed amounts directly against the state average rather than relying on the hospital's gross chargemaster list.