CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Astria Toppenish Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $358
Cash Discount Price: $686
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Astria Toppenish Hospital is $358. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $686. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.47x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$686

Average discount available for prompt cash payment at this facility.

Insurance Median

$358

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $686 (281%)

Insurance Median: $358 (147%)

Cash: $686 (281% of Medicare)

Ins. Median: $358 (147% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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	$170 - $620	70%
Ambetter / Centene	$229	94%
UnitedHealthcare	$229 - $872	94%
Va	$229	94%
Molina	$234	96%
Medicare (plans)	$236 - $872	97%
Li	$244	100%
Aetna	$250 - $929	103%
Cigna	$250	103%
Humana	$250 - $1,056	103%
Tricare	$250	103%
Zenith	$252	103%
Molina_Exchange	$298	122%
Regence	$358	147%
Premera	$398	163%
Premera_Affordable_Care	$398	163%
Chpw_Cascade_Care	$665	273%
First_Choice	$729	299%
Tpsc	$824	338%
Kaiser	$935	384%
Bcchp	$1,056	433%
Great_Rivers	$1,056	433%
Healthcomp	$1,056	433%
Washington_State_Hca	$1,056	433%

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 $686.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 73721.

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 73721.
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.