Blood transfusion
Facility: Regional Medical Center
Billing Code: 36430 (CPT)
- CPT Billing Code: 36430
- Insurance Median: $870
- Cash Discount Price: $734
- vs. Medicare Baseline: 1.93x 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 193% |
Consumer Guidance & Cost Commentary
For a self-pay patient, the most important first step is to confirm whether the facility offers a "prompt-pay" discount, which can significantly lower the final cost by paying upfront. In this case, the cash median rate is $734, which is notably lower than the negotiated rate of $870 paid by Medical Associates Health Plan - Tri. Because commercial insurance contracts often include administrative overhead that inflates the baseline price, paying cash directly can sometimes be the most cost-effective option, especially for patients with high deductibles. It is always recommended to explicitly request a self-pay or prompt-pay classification before scheduling to ensure you receive this reduced rate.
The broader pricing context reveals that this service is priced higher than the Medicare benchmark but within expected commercial ranges. The Medicare amount for this procedure is $450.73, and the cash rate of $734 represents a markup relative to this federal baseline. While the facility is a Critical Access Hospital in Manchester, Iowa, with a government local ownership structure, the specific data provided does not include comparative averages for the state or county. Therefore, the comparison relies on the federal Medicare rate as the objective cost baseline, showing that the commercial cash rate is nearly double the Medicare amount, which aligns with typical pricing dynamics for shoppable services.