CMS Price Transparency Data

Blood transfusion

Facility: PAM Rehabilitation Hospital of Victoria

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $302
Cash Discount Price: $428
vs. Medicare Baseline: 0.67x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at PAM Rehabilitation Hospital of Victoria is $302. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $428. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.67x the Medicare baseline. Located in 101 James Coleman Dr, Victoria, TX.

Cash / Self-Pay

$428

Average discount available for prompt cash payment at this facility.

Insurance Median

$302

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: $428 (95%)

Insurance Median: $302 (67%)

Cash: $428 (95% of Medicare)

Ins. Median: $302 (67% 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
America'S Choice Provider Network	$18 - $581	4%
Provider Network Of America	$19 - $623	4%
Quik Trip	$19 - $623	4%
Usa Managed Care Organization	$19 - $623	4%
Velocity Provider Ppo Network	$19 - $623	4%
Multiplan/Phcs	$20 - $664	4%
Prime Health Services	$21 - $706	5%
Medincrease	$22 - $747	5%

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 $428.
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 PAM Rehabilitation Hospital of Victoria 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.