CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Astria Toppenish Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99203
  • Insurance Median: $137
  • Cash Discount Price: $157
  • vs. Medicare Baseline: 1.17x Medicare
The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Astria Toppenish Hospital is $137. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $157. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.17x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.
Cash / Self-Pay
$157

Average discount available for prompt cash payment at this facility.

Insurance Median
$137

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)
Cash / Self-Pay: $157 (134%)
Insurance Median: $137 (117%)
Cash: $157 (134% of Medicare)
Ins. Median: $137 (117% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 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.

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 $21 - $445 18%
Ambetter / Centene $23 - $150 20%
Molina $23 - $153 20%
UnitedHealthcare $23 - $735 20%
Va $23 - $161 20%
Medicare (plans) $24 - $735 20%
Molina_Exchange $30 - $194 26%
Premera_Affordable_Care $51 - $336 43%
Li $56 - $287 48%
Chpw_Cascade_Care $86 - $561 73%
Aetna $88 - $783 75%
First_Choice $94 - $614 80%
Tpsc $106 - $694 90%
Kaiser $108 - $550 92%
Bcchp $136 - $890 116%
Great_Rivers $136 - $890 116%
Healthcomp $136 - $890 116%
Humana $136 - $890 116%
Washington_State_Hca $136 - $890 116%
Premera $336 286%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 502 W Fourth Ave, Toppenish, WA 98948
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals