CMS Price Transparency Data

Blood transfusion

Facility: Lexington Memorial Hospital Inc

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 36430
  • Insurance Median: $437
  • Cash Discount Price: $495
  • vs. Medicare Baseline: 0.97x Medicare
The contracted insurance negotiated median rate for a Blood transfusion at Lexington Memorial Hospital Inc is $437. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $495. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.97x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.
Cash / Self-Pay
$495

Average discount available for prompt cash payment at this facility.

Insurance Median
$437

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: $495 (110%)
Insurance Median: $437 (97%)
Cash: $495 (110% of Medicare)
Ins. Median: $437 (97% 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.

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
Amerihealth $187 - $272 41%
Carolina Complete $187 41%
Healthy Blue $187 41%
Partners $187 41%
UnitedHealthcare $188 - $444 42%
Vaya $188 42%
Wellcare $188 42%
Alliance $190 42%
Trillium $192 43%
Medcost $217 - $662 48%
Blue Cross Blue Shield $247 - $395 55%
Aetna $281 - $915 62%
Ambetter / Centene $284 63%
Oscar $317 - $436 70%
Cigna $431 - $439 96%
Directnet $585 130%
Healthgram Lexington Home Brands $713 158%
Healthgram $792 176%
Private Healthcare Systems $812 180%
Beechstreet $871 193%
Humana $871 193%
Multiplan $891 198%
National Provider Network $891 198%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 250 Hospital Drive Po Box 1817, Lexington, NC 27293
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals