CMS Price Transparency Data

Blood test, cholesterol (lipid panel)

Facility: Astria Toppenish Hospital

Billing Code: 80061 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80061
Insurance Median: $123
Cash Discount Price: $211
vs. Medicare Baseline: 9.19x Medicare

The contracted insurance negotiated median rate for a Blood test, cholesterol (lipid panel) at Astria Toppenish Hospital is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $211. Compared to the federal Medicare reimbursement reference rate of $13.39, this hospital’s rate is 9.19x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$211

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

$13.39

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $13.39 (100%)

Cash / Self-Pay: $211 (1576%)

Insurance Median: $123 (919%)

Cash: $211 (1576% of Medicare)

Ins. Median: $123 (919% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $13.39 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 919% of the Medicare baseline (a markup of 819%). 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	$6 - $52	45%
Ambetter / Centene	$7	52%
UnitedHealthcare	$7 - $283	52%
Va	$7	52%
Medicare (plans)	$8 - $283	60%
Molina	$8	60%
Molina_Exchange	$10	75%
Aetna	$13 - $302	97%
Cigna	$13	97%
Humana	$13 - $343	97%
Li	$13	97%
Tricare	$13	97%
Zenith	$14	105%
Kaiser	$51	381%
Regence	$104 - $116	777%
Premera	$116 - $129	866%
Premera_Affordable_Care	$116 - $129	866%
Chpw_Cascade_Care	$193 - $216	1441%
First_Choice	$212 - $237	1583%
Tpsc	$239 - $268	1785%
Bcchp	$307 - $343	2293%
Great_Rivers	$307 - $343	2293%
Healthcomp	$307 - $343	2293%
Washington_State_Hca	$307 - $343	2293%

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 $211.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80061.

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 80061.
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.