CMS Price Transparency Data

Culture, blood

Facility: Astria Toppenish Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $18
Cash Discount Price: $171
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Astria Toppenish Hospital is $18. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $171. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 1.74x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$171

Average discount available for prompt cash payment at this facility.

Insurance Median

$18

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.32

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.32 (100%)

Cash / Self-Pay: $171 (1657%)

Insurance Median: $18 (174%)

Cash: $171 (1657% of Medicare)

Ins. Median: $18 (174% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.32 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	$5 - $40	48%
Ambetter / Centene	$6	58%
UnitedHealthcare	$6 - $217	58%
Va	$6	58%
Medicare (plans)	$7 - $217	68%
Molina	$7	68%
Molina_Exchange	$8	78%
Aetna	$10 - $231	97%
Cigna	$10	97%
Humana	$10 - $263	97%
Li	$10	97%
Tricare	$10	97%
Zenith	$10	97%
Kaiser	$39	378%
Regence	$89	862%
Premera	$99	959%
Premera_Affordable_Care	$99	959%
Chpw_Cascade_Care	$166	1609%
First_Choice	$181	1754%
Tpsc	$205	1986%
Bcchp	$263	2548%
Great_Rivers	$263	2548%
Healthcomp	$263	2548%
Washington_State_Hca	$263	2548%

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 $171.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87040.

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 87040.
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.