CMS Price Transparency Data

CT scan, sinuses

Facility: Astria Toppenish Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $196
Cash Discount Price: $739
vs. Medicare Baseline: 1.84x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Astria Toppenish Hospital is $196. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $739. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.84x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$739

Average discount available for prompt cash payment at this facility.

Insurance Median

$196

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $739 (692%)

Insurance Median: $196 (184%)

Cash: $739 (692% of Medicare)

Ins. Median: $196 (184% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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.

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	$78 - $358	73%
Ambetter / Centene	$105	98%
UnitedHealthcare	$105 - $939	98%
Va	$105	98%
Molina	$107	100%
Medicare (plans)	$108 - $939	101%
Aetna	$112 - $1,001	105%
Cigna	$112	105%
Humana	$112 - $1,137	105%
Tricare	$112	105%
Zenith	$113	106%
Li	$116	109%
Molina_Exchange	$137	128%
Regence	$385	360%
Premera	$429	402%
Premera_Affordable_Care	$429	402%
Kaiser	$443	415%
Chpw_Cascade_Care	$716	670%
First_Choice	$785	735%
Tpsc	$887	830%
Bcchp	$1,137	1065%
Great_Rivers	$1,137	1065%
Healthcomp	$1,137	1065%
Washington_State_Hca	$1,137	1065%

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 $739.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70486.

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 70486.
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.