Blood transfusion
Facility: Bob Wilson Memorial Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $870
- Cash Discount Price: $426
- vs. Medicare Baseline: 1.93x 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 |
|---|---|---|
| Aetna | $341 - $852 | 76% |
| Medicare (plans) | $341 | 76% |
| UnitedHealthcare | $341 - $889 | 76% |
| Humana | $341 | 76% |
| Kansas Health | $341 | 76% |
| Centura Employee Plan | $533 | 118% |
| Blue Cross Blue Shield | $688 | 153% |
| Multiplan | $959 - $991 | 213% |
| Health Partners Of Kansas | $1,001 | 222% |
| Wppa | $1,012 | 225% |
Consumer Guidance & Cost Commentary
For CPT code 36430, a blood transfusion, Bob Wilson Memorial Hospital in Ulysses, KS, lists a gross charge of $1,065.00, which is significantly higher than the facility's cash median of $426.00. While the hospital is a Critical Access Hospital owned by a voluntary non-profit church, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. For instance, UnitedHealthcare and Multiplan have negotiated ranges reaching up to $889 and $991 respectively, whereas the cash rate is substantially lower. This dynamic suggests that patients with high-deductible plans might save money by paying the cash price directly, provided they can secure a "self-pay" or "prompt-pay" discount from the hospital before scheduling services.
It is important to distinguish between the hospital's gross charges and the actual amount your insurance will pay, as balance billing can occur if you receive care from out-of-network providers or ancillary services not covered by your plan. Although the No Surprises Act protects emergency care at in-network facilities, unexpected bills may still arise from non-emergency services or out-of-network lab work. To avoid these surprises, always request an itemized bill before paying, as summary invoices can obscure individual code costs and lead to double-billing or unbundling errors. Furthermore, since Medicare rates for this service are $450.73, comparing your commercial negotiated rate to this benchmark rather than the inflated gross charge provides a clearer picture of the facility's pricing markup and ensures you are not overpaying for care.