CMS Price Transparency Data

Blood test, PSA (prostate screen)

Facility: Astria Toppenish Hospital

Billing Code: 84153 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84153
Insurance Median: $293
Cash Discount Price: $309
vs. Medicare Baseline: 15.93x Medicare

The contracted insurance negotiated median rate for a Blood test, PSA (prostate screen) at Astria Toppenish Hospital is $293. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $309. Compared to the federal Medicare reimbursement reference rate of $18.39, this hospital’s rate is 15.93x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$309

Average discount available for prompt cash payment at this facility.

Insurance Median

$293

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$18.39

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $18.39 (100%)

Cash / Self-Pay: $309 (1680%)

Insurance Median: $293 (1593%)

Cash: $309 (1680% of Medicare)

Ins. Median: $293 (1593% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $18.39 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 1593% of the Medicare baseline (a markup of 1493%). 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	$8 - $78	44%
Ambetter / Centene	$11	60%
Medicare (plans)	$11 - $420	60%
Molina	$11	60%
UnitedHealthcare	$11 - $420	60%
Va	$11	60%
Molina_Exchange	$14	76%
Aetna	$18 - $448	98%
Cigna	$18	98%
Humana	$18 - $509	98%
Li	$18	98%
Tricare	$18	98%
Zenith	$19	103%
Kaiser	$70	381%
Regence	$144 - $173	783%
Premera	$160 - $192	870%
Premera_Affordable_Care	$160 - $192	870%
Chpw_Cascade_Care	$267 - $321	1452%
First_Choice	$293 - $351	1593%
Tpsc	$331 - $397	1800%
Bcchp	$424 - $509	2306%
Great_Rivers	$424 - $509	2306%
Healthcomp	$424 - $509	2306%
Washington_State_Hca	$424 - $509	2306%

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 $309.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 84153.

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 84153.
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.