CMS Price Transparency Data

Blood transfusion

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 36430
  • Insurance Median: $906
  • Cash Discount Price: $565
  • vs. Medicare Baseline: 2.01x Medicare
The contracted insurance negotiated median rate for a Blood transfusion at Carilion Stonewall Jackson Hospital is $906. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $565. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 2.01x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.
Cash / Self-Pay
$565

Average discount available for prompt cash payment at this facility.

Insurance Median
$906

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: $565 (125%)
Insurance Median: $906 (201%)
Cash: $565 (125% of Medicare)
Ins. Median: $906 (201% 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 201% of the Medicare baseline (a markup of 101%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

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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 $38 - $2,059 8%
Sentara Health Plan $39 - $1,001 9%
Abh of VA (Formerly Coventry) $40 9%
Abh of Wva (Formerly Coventry) $40 9%
Humana $40 - $420 9%
UnitedHealthcare $40 - $1,320 9%
Aetna $387 - $1,072 86%
Gateway - Tier 3 $888 197%
Vhn - Ultra $1,001 222%
Connecticare $1,130 251%
Gateway - Tier 2 $1,292 287%
Vhn - Plus $1,292 287%
Cigna $1,294 287%
Integrated Health Plan $1,373 305%
Vhn $1,373 305%
Vhn - Link $1,454 323%
Beech Street $1,486 330%
Gateway - Tier 1 $1,534 340%
Vhn - Secondary Payors $1,534 340%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1 Health Circle, Lexington, VA 24450
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals