CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Astria Toppenish Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97750
Insurance Median: $93
Cash Discount Price: $151
vs. Medicare Baseline: 2.76x Medicare

The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Astria Toppenish Hospital is $93. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $151. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.76x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$151

Average discount available for prompt cash payment at this facility.

Insurance Median

$93

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$33.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $33.73 (100%)

Cash / Self-Pay: $151 (448%)

Insurance Median: $93 (276%)

Cash: $151 (448% of Medicare)

Ins. Median: $93 (276% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $33.73 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 276% of the Medicare baseline (a markup of 176%). 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	$16 - $60	47%
Ambetter / Centene	$20	59%
Medicare (plans)	$20 - $203	59%
UnitedHealthcare	$20 - $203	59%
Va	$20 - $161	59%
Molina	$21	62%
Molina_Exchange	$26	77%
Li	$34	101%
Aetna	$35 - $216	104%
Cigna	$35	104%
Humana	$35 - $246	104%
Tricare	$35	104%
Zenith	$35	104%
Premera_Affordable_Care	$40 - $93	119%
Chpw_Cascade_Care	$67 - $155	199%
First_Choice	$73 - $170	216%
Regence	$79 - $83	234%
Tpsc	$83 - $192	246%
Premera	$88 - $93	261%
Bcchp	$106 - $246	314%
Great_Rivers	$106 - $246	314%
Healthcomp	$106 - $246	314%
Washington_State_Hca	$106 - $246	314%
Kaiser	$132	391%

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 $151.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97750.

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 97750.
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.