CMS Price Transparency Data

Blood transfusion

Facility: Tristar Ashland City Medical Center

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $932
Cash Discount Price: $1,455
vs. Medicare Baseline: 2.07x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Tristar Ashland City Medical Center is $932. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,455. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.07x the Medicare baseline. Located in 313 North Main St, Ashland City, TN.

Cash / Self-Pay

$1,455

Average discount available for prompt cash payment at this facility.

Insurance Median

$932

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: $1,455 (323%)

Insurance Median: $932 (207%)

Cash: $1,455 (323% of Medicare)

Ins. Median: $932 (207% 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 207% of the Medicare baseline (a markup of 107%). 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
Bright Health	$247 - $827	55%
Kentucky Labor Cabinet	$268	59%
Ambetter / Centene	$325 - $338	72%
United	$355 - $2,577	79%
Humana	$364 - $2,569	81%
Cigna	$367 - $3,454	81%
Aetna	$408 - $2,303	91%
Amerigroup	$451	100%
Blue Cross Blue Shield	$495 - $2,371	110%
Bgfh Singlesource	$728 - $1,237	162%
Multiplan	$800	177%
Southern Health Partners	$873	194%
Oscar	$990	220%
Employers Health Network	$1,019	226%
Odom'S Tn Pride Sausage	$1,092	242%
Beech Street	$1,339	297%
Apex Health	$2,550	566%
Nhc Advantage, Inc.	$2,550	566%
Pruitt Health (Allyalign)	$2,550	566%

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 $1,455.
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 Tristar Ashland City 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.