CMS Price Transparency Data

Blood transfusion

Facility: Prisma Health Tuomey Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 36430
  • Insurance Median: $562
  • Cash Discount Price: $1,531
  • vs. Medicare Baseline: 1.25x Medicare
The contracted insurance negotiated median rate for a Blood transfusion at Prisma Health Tuomey Hospital is $562. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,531. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.25x the Medicare baseline. Located in 129 N Washington St, Sumter, SC.
Cash / Self-Pay
$1,531

Average discount available for prompt cash payment at this facility.

Insurance Median
$562

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: $1,531 (340%)
Insurance Median: $562 (125%)
Cash: $1,531 (340% of Medicare)
Ins. Median: $562 (125% 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
Medicaid / KanCare $64 - $363 14%
Humana $69 - $1,766 15%
Blue Cross Blue Shield $298 - $1,297 66%
Bluechoice [810] $298 - $1,297 66%
UnitedHealthcare $363 - $3,736 81%
Tricare $409 91%
Cigna $412 - $1,806 91%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904] $412 91%
Medicare (plans) $412 - $433 91%
Triwest Healthcare Alliance Vcp [902] $412 91%
Va Community Care Network-Vaccn [903] $412 91%
Aetna $433 - $1,860 96%
Healthy Conn Prime-First Choice Vip Care [5300] $433 96%
Healthy Conn Prime-Molina Healthcare [5330] $433 96%
Healthy Conn Prime-Wellcare Prime By Atc [5310] $433 96%
Prisma Health Seniorcare Pace - Midlands [5400] $546 121%
Prisma Health Seniorcare Pace-Upstate [5200] $546 121%
Workers Comp [600] $577 128%
Scdc-Sc Dept Of Corrections [7232] $714 158%
Ambetter / Centene $759 168%
Promise Health Plan Contracted [2401] $824 - $1,413 183%
Orangeburg Senior Helping Center Pace [5401] $942 209%
Planned Administrators [820] $1,297 288%
Bob Jones Univ-Pai [821] $1,413 313%
Meritain Health Contracted [2200] $1,507 - $1,860 334%
Preferred Administrators Contracted [2839] $1,648 366%
Medcost [2940] $1,743 - $1,955 387%
Atlantic Packaging Contracted [4833] $1,766 392%
Aps Healthcare System [2981] $1,884 418%
Multiplan/Phcs Contracted [2950] $2,096 465%
Vsp Vision Care [2986] $2,120 470%
First Health Contracted [2952] $2,190 486%
Furman Int/Allen University Student [2951] $2,190 486%
Quiktrip-First Health [3067] $2,190 486%
Golden Rule Insurance Company [2991] $3,736 829%
Oxford Health Plans [2992] $3,736 829%
Zzumr-Salt Lake City Ut [3169] $3,736 829%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 129 N Washington St, Sumter, SC 29150
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals