CMS Price Transparency Data

Blood transfusion

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $394
Cash Discount Price: $418
vs. Medicare Baseline: 0.87x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Munson Healthcare Otsego Memorial Hospital is $394. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $418. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.87x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$418

Average discount available for prompt cash payment at this facility.

Insurance Median

$394

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$450.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $450.73 (100%)

Cash / Self-Pay: $418 (93%)

Insurance Median: $394 (87%)

Cash: $418 (93% of Medicare)

Ins. Median: $394 (87% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$13 - $776	3%
UnitedHealthcare	$41 - $995	9%
Aetna	$44 - $1,006	10%
Blue Care Network	$44 - $440	10%
Hap (Health Alliance Plan)	$44 - $994	10%
Humana	$44 - $440	10%
Mclaren Health Plan	$44 - $1,041	10%
Medicare (plans)	$44 - $440	10%
Michigan Amish Medical Board	$44 - $440	10%
Northern Michigan Mennonite Group	$44 - $440	10%
Priority Health	$44 - $440	10%
Molina	$47 - $475	10%
Asr Physicians Care Network	$65 - $994	14%
Cigna	$69 - $107	15%
Nomi Health	$70 - $994	16%
Employee Benefit Logistics	$74 - $747	16%
Meridian	$230	51%
Hospice Of Michigan	$283 - $745	63%
Munson Hospice	$330 - $869	73%
Enterprise Group Planning/Employee Benefit Plan	$377 - $994	84%
Cofinity	$400 - $1,056	89%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$400 - $1,056	89%
Three Rivers Provider Network	$400 - $1,056	89%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $418.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 36430.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Munson Healthcare Otsego Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 36430.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.