CMS Price Transparency Data

Blood test, average blood sugar (A1c)

Facility: Astria Toppenish Hospital

Billing Code: 83036 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 83036
Insurance Median: $64
Cash Discount Price: $142
vs. Medicare Baseline: 6.59x Medicare

The contracted insurance negotiated median rate for a Blood test, average blood sugar (A1c) at Astria Toppenish Hospital is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $142. Compared to the federal Medicare reimbursement reference rate of $9.71, this hospital’s rate is 6.59x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$142

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$9.71

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $9.71 (100%)

Cash / Self-Pay: $142 (1462%)

Insurance Median: $64 (659%)

Cash: $142 (1462% of Medicare)

Ins. Median: $64 (659% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $9.71 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 659% of the Medicare baseline (a markup of 559%). 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 - $39	31%
Ambetter / Centene	$4	41%
Molina	$4	41%
UnitedHealthcare	$4 - $211	41%
Va	$4	41%
Medicare (plans)	$5 - $211	51%
Molina_Exchange	$6	62%
Aetna	$10 - $225	103%
Cigna	$10	103%
Humana	$10 - $256	103%
Li	$10	103%
Tricare	$10	103%
Zenith	$10	103%
Regence	$22 - $87	227%
Premera	$24 - $97	247%
Premera_Affordable_Care	$24 - $97	247%
Kaiser	$37	381%
Chpw_Cascade_Care	$40 - $161	412%
First_Choice	$44 - $177	453%
Tpsc	$50 - $200	515%
Bcchp	$64 - $256	659%
Great_Rivers	$64 - $256	659%
Healthcomp	$64 - $256	659%
Washington_State_Hca	$64 - $256	659%

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 $142.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 83036.

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 83036.
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.