CMS Price Transparency Data

Blood transfusion

Facility: St Nicholas Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $850
Cash Discount Price: $884
vs. Medicare Baseline: 1.89x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at St Nicholas Hospital is $850. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $884. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.89x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.

Cash / Self-Pay

$884

Average discount available for prompt cash payment at this facility.

Insurance Median

$850

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: $884 (196%)

Insurance Median: $850 (189%)

Cash: $884 (196% of Medicare)

Ins. Median: $850 (189% 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
Blue Cross Blue Shield	$173 - $901	38%
Community Care Family Care	$173	38%
Managed Health Services	$173	38%
Medicaid / KanCare	$173	38%
Meridian Health Plan	$173	38%
Molina Healthcare	$183 - $423	41%
Triology	$183 - $1,058	41%
Aetna	$423 - $1,339	94%
Humana	$423 - $1,138	94%
Medica	$423	94%
Medicare (plans)	$423	94%
UnitedHealthcare	$423 - $479	94%
Security Health Plan	$427 - $855	95%
Molina Healthcare Of Wi	$670	149%
Hshs Employees	$726	161%
Arise Health Plan	$803	178%
P360 Small Group	$803	178%
Prevea Health Network	$803	178%
Wea Provider Network	$830 - $964	184%
Cigna	$937	208%
Interplan	$937	208%
Network Health Plan	$937	208%
Naphcare	$951	211%
Health Care Alliance	$977	217%
Health Eos	$1,004	223%
Healthsmart	$1,004	223%
Wisconsin Physician Service	$1,071	238%
Multiplan/Phcs	$1,125	250%
Choicecare	$1,138	252%
North Central Healthcare Alliance	$1,232	273%
First Health	$1,272	282%
Caterpillar, Inc.	$1,339	297%
Cofinity	$1,339	297%
Live360	$1,339	297%

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 $884.
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 St Nicholas Hospital 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.