CMS Price Transparency Data

Blood transfusion

Facility: Adena Pike Medical Center

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $1,153
Cash Discount Price: $765
vs. Medicare Baseline: 2.56x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Adena Pike Medical Center is $1,153. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $765. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.56x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$765

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,153

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: $765 (170%)

Insurance Median: $1,153 (256%)

Cash: $765 (170% of Medicare)

Ins. Median: $1,153 (256% 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 256% of the Medicare baseline (a markup of 156%). 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
Aetna	$367 - $1,246	81%
Blue Cross Blue Shield	$367 - $1,320	81%
Buckeye Community Health Plan	$367	81%
Humana	$367 - $1,454	81%
Medical Mutual Of Ohio	$367 - $972	81%
Medigold	$367	81%
Molina	$367	81%
Care Source	$375	83%
Gateway Health	$505	112%
Molina Marketplace	$602	134%
Care Source Just4Me	$661	147%
UnitedHealthcare	$975 - $1,316	216%
Sidecar Health	$1,010	224%
Ohio Ppo Connect	$1,071	238%
The Health Plan	$1,071	238%
Cigna	$1,108	246%
Medical Mutual Of Ohio Supermed	$1,153	256%
First Health	$1,200	266%
Ohio Health Choice	$1,218	270%
Integrated Health Plan	$1,438	319%
Healthsmart	$1,454	323%
Multiplan/Private Healthcare Systems	$1,454	323%
Three Rivers Network	$1,454	323%

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 $765.
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 Adena Pike Medical Center 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.