CMS Price Transparency Data

Blood transfusion

Facility: Lodi Community Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,206
Cash Discount Price: $1,452
vs. Medicare Baseline: 2.68x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Lodi Community Hospital is $1,206. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,452. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.68x the Medicare baseline. Located in 225 Elyria Street, Lodi, OH.

Cash / Self-Pay

$1,452

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,206

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: $1,452 (322%)

Insurance Median: $1,206 (268%)

Cash: $1,452 (322% of Medicare)

Ins. Median: $1,206 (268% 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 268% of the Medicare baseline (a markup of 168%). 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	$437 - $1,828	97%
UnitedHealthcare	$437 - $1,385	97%
Buckeye	$558	124%
Caresource	$558	124%
Molina	$586	130%
United	$586 - $1,595	130%
Amerihealth	$614	136%
Humana	$670	149%
Mmo	$670 - $1,909	149%
Summacare	$670 - $1,369	149%
Oscar	$673 - $859	149%
Aetna	$760 - $2,234	169%
The Health Plan	$894 - $1,787	198%
Amish Community Aid Plan	$1,005 - $1,117	223%
Ohcp	$1,086	241%
Aultcare	$1,117	248%
Omas	$1,117	248%
Ohio Healthy	$1,206	268%
Php	$1,340	297%
Phphi	$1,340	297%
Upmc	$1,340	297%
Cigna	$1,441	320%
Cc Ehp	$1,501	333%
Gms	$1,564	347%
Medical Benefit Corp	$1,564	347%
Consociate Health	$1,676	372%
Frontpath	$2,011	446%
Managed Care Services	$2,011	446%
Multiplan	$2,011	446%
Tertiary Care Network	$2,011	446%

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 $1,452.
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 Lodi Community 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.