CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: Astria Toppenish Hospital

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $71
Cash Discount Price: $119
vs. Medicare Baseline: 9.14x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at Astria Toppenish Hospital is $71. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $119. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 9.14x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$119

Average discount available for prompt cash payment at this facility.

Insurance Median

$71

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$7.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $7.77 (100%)

Cash / Self-Pay: $119 (1532%)

Insurance Median: $71 (914%)

Cash: $119 (1532% of Medicare)

Ins. Median: $71 (914% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $7.77 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 914% of the Medicare baseline (a markup of 814%). 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	$4 - $30	51%
Ambetter / Centene	$5	64%
Medicare (plans)	$5 - $164	64%
Molina	$5	64%
UnitedHealthcare	$5 - $164	64%
Va	$5	64%
Molina_Exchange	$7	90%
Aetna	$8 - $174	103%
Cigna	$8	103%
Humana	$8 - $198	103%
Li	$8	103%
Tricare	$8	103%
Zenith	$8	103%
Kaiser	$30	386%
Regence	$57 - $67	734%
Premera	$63 - $75	811%
Premera_Affordable_Care	$63 - $75	811%
Chpw_Cascade_Care	$106 - $125	1364%
First_Choice	$116 - $137	1493%
Tpsc	$131 - $154	1686%
Bcchp	$168 - $198	2162%
Great_Rivers	$168 - $198	2162%
Healthcomp	$168 - $198	2162%
Washington_State_Hca	$168 - $198	2162%

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 $119.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85025.

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 85025.
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.