Blood transfusion
Facility: William Newton Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $642
- Cash Discount Price: $1,418
- vs. Medicare Baseline: 1.42x 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 |
|---|---|---|
| Ambetter / Centene | $31 - $1,840 | 7% |
| Triwest- All Plans | $40 - $642 | 9% |
| UnitedHealthcare | $42 - $1,656 | 9% |
| Blue Cross Blue Shield | $42 - $662 | 9% |
| Providrs Care Nexus | $641 - $1,126 | 142% |
| Providrs Care - All Other Plans | $733 - $1,288 | 163% |
Consumer Guidance & Cost Commentary
For this blood transfusion service at William Newton Hospital in Winfield, KS, the cash price of $1,418 is significantly higher than the state average, which is approximately 1.4 times the Medicare benchmark rate of $450.73. While commercial insurance plans like Ambetter / Centene and Triwest- All Plans have negotiated rates ranging from $31 to $1,840, these figures often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that the facility is a Critical Access Hospital owned by the local government, and while the median negotiated amount across all payers is $642, this does not guarantee the lowest possible cost for every individual plan.
Patients should be aware that balance billing can occur if a provider bills the full chargemaster rate instead of the insurance allowed amount, though the No Surprises Act protects against surprise bills for emergency care at in-network facilities. To avoid unexpected costs, consumers should request a full itemized billing audit before paying, as summary bills often hide unbundled charges or services not rendered. Additionally, since hospitals frequently offer prompt-pay discounts for upfront cash payments, it is advisable to ask the billing department specifically about self-pay or prompt-pay rates before scheduling, as waiting until after insurance submission may void these potential savings.