Blood transfusion
Facility: Oakleaf Surgical Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $437
- Cash Discount Price: $1,084
- vs. Medicare Baseline: 0.97x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $437 | 97% |
| Dean Health Plan | $437 | 97% |
| Group Health Cooperative Of Eau Claire | $437 | 97% |
| Healthpartners | $437 | 97% |
| Humana | $437 | 97% |
| Medica | $437 | 97% |
| Quartz Health Solutions | $437 | 97% |
| Security Health Plan Of Wi | $437 - $876 | 97% |
| Ucare Wi | $437 | 97% |
| UnitedHealthcare | $437 | 97% |
Consumer Guidance & Cost Commentary
For a blood transfusion procedure at Oakleaf Surgical Hospital in Altoona, WI, the facility's cash median rate of $1,084 is notably higher than the Medicare benchmark of $450.73, reflecting the standard markup often seen in commercial pricing. While the facility's gross charge is $1,204, patients with high-deductible plans or those seeking to minimize out-of-pocket costs may find that paying the cash rate of $1,084 upfront is more economical than relying on insurance, which negotiates a rate of $437 but often requires the patient to meet their deductible first. It is important to note that while the cash price is higher than the Medicare baseline, it remains lower than the gross charge, and patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts to further reduce the final amount owed.
The data indicates that 10 payers have negotiated contracts with this facility, with most setting a uniform rate of $437, though Security Health Plan Of Wi has a high rate of $876 for some of its plans. Because negotiated rates frequently include administrative overhead and are often higher than cash prices, patients should not assume that being in-network guarantees the lowest possible price. To ensure transparency and avoid unexpected charges, consumers are advised to request a full itemized CPT-coded bill before paying, as summary bills can obscure individual costs. Furthermore, if any balance billing occurs from out-of-network ancillary services, patients should utilize the No Surprises Act to dispute the bill rather than paying immediately, and avoid signing consent waivers that might waive their rights to these protections.