CMS Price Transparency Data

Blood antibody screen

Facility: Astria Toppenish Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $123
Cash Discount Price: $171
vs. Medicare Baseline: 2.31x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Astria Toppenish Hospital is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $171. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 2.31x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$171

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$53.24

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $53.24 (100%)

Cash / Self-Pay: $171 (321%)

Insurance Median: $123 (231%)

Cash: $171 (321% of Medicare)

Ins. Median: $123 (231% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $53.24 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 231% of the Medicare baseline (a markup of 131%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Medicaid / KanCare	$3 - $97	6%
Ambetter / Centene	$4	8%
Medicare (plans)	$4 - $270	8%
Molina	$4	8%
UnitedHealthcare	$4 - $270	8%
Va	$4	8%
Molina_Exchange	$5	9%
Li	$53	100%
Aetna	$55 - $288	103%
Cigna	$55	103%
Humana	$55 - $327	103%
Tricare	$55	103%
Zenith	$56	105%
Regence	$68 - $111	128%
Premera	$75 - $123	141%
Premera_Affordable_Care	$75 - $123	141%
Chpw_Cascade_Care	$126 - $206	237%
First_Choice	$138 - $226	259%
Tpsc	$156 - $255	293%
Bcchp	$200 - $327	376%
Great_Rivers	$200 - $327	376%
Healthcomp	$200 - $327	376%
Washington_State_Hca	$200 - $327	376%
Kaiser	$202	379%

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 $171.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 86850.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Astria Toppenish Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 86850.
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.