CMS Price Transparency Data

Blood test, hemoglobin

Facility: Astria Toppenish Hospital

Billing Code: 85018 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85018
Insurance Median: $23
Cash Discount Price: $39
vs. Medicare Baseline: 9.70x Medicare

The contracted insurance negotiated median rate for a Blood test, hemoglobin at Astria Toppenish Hospital is $23. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $39. Compared to the federal Medicare reimbursement reference rate of $2.37, this hospital’s rate is 9.70x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$39

Average discount available for prompt cash payment at this facility.

Insurance Median

$23

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$2.37

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $2.37 (100%)

Cash / Self-Pay: $39 (1646%)

Insurance Median: $23 (970%)

Cash: $39 (1646% of Medicare)

Ins. Median: $23 (970% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $2.37 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 970% of the Medicare baseline (a markup of 870%). 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
Aetna	$2 - $55	84%
Cigna	$2	84%
Humana	$2 - $62	84%
Li	$2	84%
Medicaid / KanCare	$2 - $9	84%
Medicare (plans)	$2 - $51	84%
Tricare	$2	84%
Zenith	$2	84%
Ambetter / Centene	$5	211%
Molina	$5	211%
UnitedHealthcare	$5 - $51	211%
Va	$5	211%
Molina_Exchange	$7	295%
Kaiser	$9	380%
Regence	$20 - $21	844%
Premera	$22 - $23	928%
Premera_Affordable_Care	$22 - $23	928%
Chpw_Cascade_Care	$37 - $39	1561%
First_Choice	$40 - $43	1688%
Tpsc	$45 - $48	1899%
Bcchp	$58 - $62	2447%
Great_Rivers	$58 - $62	2447%
Healthcomp	$58 - $62	2447%
Washington_State_Hca	$58 - $62	2447%

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 $39.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85018.

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 85018.
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.