CMS Price Transparency Data

Blood transfusion

Facility: Tomah Memorial Hospital

Billing Code: 36430 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 36430
Insurance Median: $729
Cash Discount Price: $752
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a Blood transfusion at Tomah Memorial Hospital is $729. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $752. Compared to the federal Medicare reimbursement reference rate of $450.73, this hospital’s rate is 1.62x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$752

Average discount available for prompt cash payment at this facility.

Insurance Median

$729

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: $752 (167%)

Insurance Median: $729 (162%)

Cash: $752 (167% of Medicare)

Ins. Median: $729 (162% 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	$316 - $1,604	70%
Group Hlth Mcr Adv - All Plans	$316 - $593	70%
Humana	$316 - $1,613	70%
Independent Care Mcr - All Other Plans	$316 - $593	70%
Quartz Mcr Adv	$316 - $593	70%
Security Hp Mcr Adv	$316 - $593	70%
UnitedHealthcare	$316 - $1,645	70%
Va Ccn - All Plans	$316 - $593	70%
Aetna	$604 - $1,482	134%
Cigna	$706 - $1,692	157%
Independent Care Mcaid	$729	162%
Managed Hlth Mcaid - All Plans	$729	162%
Quartz Mcaid	$729	162%
Security Hp Mcaid	$729	162%
Security Hp Comm - All Other Plans	$790 - $1,482	175%
Quartz Comm - All Other Plans	$837 - $1,570	186%
The Alliance - All Plans	$864 - $1,622	192%

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 $752.
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 Tomah Memorial 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.