CMS Price Transparency Data

Blood transfusion

Facility: Sycamore Shoals Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 36430
  • Insurance Median: $400
  • Cash Discount Price: $119
  • vs. Medicare Baseline: 0.89x Medicare
The contracted insurance negotiated median rate for a Blood transfusion at Sycamore Shoals Hospital is $400. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $119. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.89x the Medicare baseline. Located in 1501 West Elk Avenue, Elizabethton, TN.
Cash / Self-Pay
$119

Average discount available for prompt cash payment at this facility.

Insurance Median
$400

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: $119 (26%)
Insurance Median: $400 (89%)
Cash: $119 (26% of Medicare)
Ins. Median: $400 (89% 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
Blue Cross Blue Shield $36 - $598 8%
Sentara Health $221 - $400 49%
UnitedHealthcare $268 - $418 59%
Medcost $279 62%
Cigna $309 - $420 69%
Amerigroup $346 - $400 77%
Aetna $400 - $622 89%
Humana $400 89%
Managed Medicaire $400 89%
Medicare (plans) $400 89%
United Mine Workers Of America $400 89%
Molina Healthcare $416 - $622 92%
Devoted Health Plan $420 93%
Nhc Advantage $420 93%
Wellcare $424 - $796 94%
First Health Coventry $597 132%
Optima Health $598 133%
Seven Corners, Inc. $796 177%
Ambetter / Centene $873 194%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1501 West Elk Avenue, Elizabethton, TN 37643
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals