CMS Price Transparency Data

Culture, bacterial

Facility: Astria Toppenish Hospital

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $198
Cash Discount Price: $280
vs. Medicare Baseline: 22.97x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at Astria Toppenish Hospital is $198. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $280. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 22.97x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$280

Average discount available for prompt cash payment at this facility.

Insurance Median

$198

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$8.62

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $8.62 (100%)

Cash / Self-Pay: $280 (3248%)

Insurance Median: $198 (2297%)

Cash: $280 (3248% of Medicare)

Ins. Median: $198 (2297% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $8.62 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 2297% of the Medicare baseline (a markup of 2197%). 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	$5 - $82	58%
Ambetter / Centene	$6	70%
UnitedHealthcare	$6 - $442	70%
Va	$6	70%
Medicare (plans)	$7 - $442	81%
Molina	$7	81%
Molina_Exchange	$8	93%
Aetna	$9 - $471	104%
Cigna	$9	104%
Humana	$9 - $535	104%
Li	$9	104%
Tricare	$9	104%
Zenith	$9	104%
Kaiser	$33	383%
Regence	$41 - $181	476%
Premera	$46 - $202	534%
Premera_Affordable_Care	$46 - $202	534%
Chpw_Cascade_Care	$77 - $337	893%
First_Choice	$84 - $369	974%
Tpsc	$95 - $417	1102%
Bcchp	$122 - $535	1415%
Great_Rivers	$122 - $535	1415%
Healthcomp	$122 - $535	1415%
Washington_State_Hca	$122 - $535	1415%

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 $280.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87070.

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 87070.
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.