CMS Price Transparency Data

Blood transfusion

Facility: Tri Valley Health System

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $960
Cash Discount Price: $1,328
vs. Medicare Baseline: 2.13x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Tri Valley Health System is $960. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,328. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.13x the Medicare baseline. Located in 1305 West Highway 6/34, Cambridge, NE.

Cash / Self-Pay

$1,328

Average discount available for prompt cash payment at this facility.

Insurance Median

$960

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: $1,328 (295%)

Insurance Median: $960 (213%)

Cash: $1,328 (295% of Medicare)

Ins. Median: $960 (213% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 213% of the Medicare baseline (a markup of 113%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$497 - $1,755	110%
Humana	$497 - $813	110%
Medica Mcr Adv	$497 - $813	110%
Medica Prime Sol	$497 - $813	110%
Tricare	$497 - $813	110%
Wellcare Mcr Adv - All Plans	$497 - $813	110%
Great Plains Mcr Adv - All Plans	$522 - $853	116%
Healthy Blue Mcaid - All Plans	$542 - $887	120%
Molina Mcaid - All Plans	$542 - $887	120%
Nebraska Total Care-All Plans	$542 - $887	120%
UnitedHealthcare	$542 - $1,773	120%
Amerigroup Mcaid - All Plans	$553 - $904	123%
Medica Chi Aco - All Other Plans	$1,016 - $1,662	225%
Medica Chi Open Access	$1,016 - $1,662	225%
Medica Ifb Aco	$1,016 - $1,662	225%
Medica Ifb Open Access	$1,016 - $1,662	225%
Midlands Choice-All Plans	$1,016 - $1,662	225%
Aetna	$1,106 - $1,810	245%
Multiplan-All Plans	$1,106 - $1,810	245%

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 $1,328.
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 Tri Valley Health System 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.