CMS Price Transparency Data

Urinalysis (automated, with microscopy)

Facility: Astria Toppenish Hospital

Billing Code: 81001 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 81001
  • Insurance Median: $26
  • Cash Discount Price: $38
  • vs. Medicare Baseline: 8.20x Medicare
The contracted insurance negotiated median rate for a Urinalysis (automated, with microscopy) at Astria Toppenish Hospital is $26. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $38. Compared to the federal Medicare reimbursement reference rate of $3.17, this hospital’s rate is 8.20x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.
Cash / Self-Pay
$38

Average discount available for prompt cash payment at this facility.

Insurance Median
$26

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$3.17

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $3.17 (100%)
Cash / Self-Pay: $38 (1199%)
Insurance Median: $26 (820%)
Cash: $38 (1199% of Medicare)
Ins. Median: $26 (820% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $3.17 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 820% of the Medicare baseline (a markup of 720%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

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
Ambetter / Centene $2 63%
Medicaid / KanCare $2 - $11 63%
UnitedHealthcare $2 - $57 63%
Va $2 63%
Aetna $3 - $61 95%
Cigna $3 95%
Humana $3 - $69 95%
Li $3 95%
Medicare (plans) $3 - $57 95%
Molina $3 95%
Molina_Exchange $3 95%
Tricare $3 95%
Zenith $3 95%
Regence $11 - $23 347%
Kaiser $12 379%
Premera $12 - $26 379%
Premera_Affordable_Care $12 - $26 379%
Chpw_Cascade_Care $21 - $43 662%
First_Choice $23 - $48 726%
Tpsc $26 - $54 820%
Bcchp $33 - $69 1041%
Great_Rivers $33 - $69 1041%
Healthcomp $33 - $69 1041%
Washington_State_Hca $33 - $69 1041%

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