CMS Price Transparency Data

Ultrasound, pelvis

Facility: Astria Toppenish Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76856
  • Insurance Median: $197
  • Cash Discount Price: $696
  • vs. Medicare Baseline: 1.84x Medicare
The contracted insurance negotiated median rate for a Ultrasound, pelvis at Astria Toppenish Hospital is $197. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $696. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.84x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.
Cash / Self-Pay
$696

Average discount available for prompt cash payment at this facility.

Insurance Median
$197

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $696 (652%)
Insurance Median: $197 (184%)
Cash: $696 (652% of Medicare)
Ins. Median: $197 (184% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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
Aetna $112 - $942 105%
Cigna $112 105%
Humana $112 - $1,071 105%
Medicaid / KanCare $112 - $235 105%
Medicare (plans) $112 - $885 105%
Tricare $112 105%
Zenith $113 106%
Li $116 109%
Ambetter / Centene $151 141%
UnitedHealthcare $151 - $885 141%
Va $151 141%
Molina $154 144%
Molina_Exchange $197 184%
Regence $363 340%
Premera $404 378%
Premera_Affordable_Care $404 378%
Kaiser $443 415%
Chpw_Cascade_Care $675 632%
First_Choice $739 692%
Tpsc $835 782%
Bcchp $1,071 1003%
Great_Rivers $1,071 1003%
Healthcomp $1,071 1003%
Washington_State_Hca $1,071 1003%

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