CMS Price Transparency Data

Blood transfusion

Facility: Unitypoint Health - Meriter

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $379
Cash Discount Price: $733
vs. Medicare Baseline: 0.84x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Unitypoint Health - Meriter is $379. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $733. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 0.84x the Medicare baseline. Located in 202 S Park St, Madison, WI.

Cash / Self-Pay

$733

Average discount available for prompt cash payment at this facility.

Insurance Median

$379

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: $733 (163%)

Insurance Median: $379 (84%)

Cash: $733 (163% of Medicare)

Ins. Median: $379 (84% 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
Aspirus	$39 - $550	9%
Blue Cross Blue Shield	$39 - $3,937	9%
Illinicare	$39 - $422	9%
Prevea 360	$39 - $1,037	9%
UnitedHealthcare	$39 - $1,756	9%
Humana	$41 - $422	9%
Meridiancare	$41 - $422	9%
Health Partners Open Network	$66 - $335	15%
Medical Associates Health Plan	$131 - $330	29%
Wellmark Uph Self-Funded	$131 - $3,937	29%
Cigna	$275 - $342	61%
Security Health Plan	$284 - $366	63%
Quartz	$286	63%
Mercy Care	$304 - $427	67%

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 $733.
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 Unitypoint Health - Meriter 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.