CMS Price Transparency Data

Blood transfusion

Facility: Sanford Vermillion Medical Center

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $872
Cash Discount Price: $990
vs. Medicare Baseline: 1.93x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Sanford Vermillion Medical Center is $872. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $990. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.93x the Medicare baseline. Located in 20 South Plum Street, Vermillion, SD.

Cash / Self-Pay

$990

Average discount available for prompt cash payment at this facility.

Insurance Median

$872

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: $990 (220%)

Insurance Median: $872 (193%)

Cash: $990 (220% of Medicare)

Ins. Median: $872 (193% 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.

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
Sanford Health Plan Align	$365	81%
Wellmark Sd	$376	83%
Ucare	$403 - $1,087	89%
Aetna	$408 - $1,075	91%
Health Partners	$408 - $928	91%
Medicare (plans)	$408	91%
UnitedHealthcare	$408 - $1,033	91%
Primewest	$416	92%
Sanford Health Plan	$490 - $657	109%
Security Health Plan	$680	151%
Medica	$1,021 - $1,091	227%
Wellmark	$1,064 - $1,076	236%
First Choice Health Network	$1,113	247%
Healthez	$1,113	247%
Multiplan	$1,113	247%

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 $990.
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 Sanford Vermillion 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.