Blood transfusion
Facility: Susan B Allen Memorial Hospital
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $554
- Cash Discount Price: $547
- vs. Medicare Baseline: 1.23x 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 |
|---|---|---|
| UnitedHealthcare | $350 | 78% |
| Providrs Care | $757 | 168% |
Consumer Guidance & Cost Commentary
For a blood transfusion at Susan B Allen Memorial Hospital in El Dorado, KS, the cash median price is $547.00, which is lower than the negotiated rates of $554.00 and $757.00 charged by UnitedHealthcare and Providrs Care, respectively. While commercial insurance contracts often result in higher allowed amounts due to administrative overhead and network tiering, paying cash upfront can sometimes be more cost-effective for patients with high-deductible plans who have not yet met their coverage thresholds. To ensure you receive the best possible rate, it is advisable to ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing the standard insurance billing cycle.
The facility's pricing for this procedure is 1.2 times the Medicare benchmark amount of $450.73, reflecting the typical markup found in commercial healthcare pricing where negotiated rates often range between 200% and 300% of the federal baseline. If you receive a bill that includes charges for out-of-network services, such as specific lab tests or physician services, you may be subject to balance billing for the difference between the provider's full charge and your insurance's allowed amount. However, under the No Surprises Act, balance billing for emergency care and non-emergency services at in-network facilities is prohibited, so you should dispute any unexpected bills immediately and request a formal audit to ensure you are not being charged for services not rendered or for unbundled components of the procedure.