CMS Price Transparency Data

Culture, blood

Facility: Astria Sunnyside Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $120
Cash Discount Price: $123
vs. Medicare Baseline: 11.63x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Astria Sunnyside Hospital is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $123. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 11.63x the Medicare baseline. Located in 1016 Tacoma Avenue, Sunnyside, WA.

Cash / Self-Pay

$123

Average discount available for prompt cash payment at this facility.

Insurance Median

$120

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.32

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.32 (100%)

Cash / Self-Pay: $123 (1192%)

Insurance Median: $120 (1163%)

Cash: $123 (1192% of Medicare)

Ins. Median: $120 (1163% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.32 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 1163% of the Medicare baseline (a markup of 1063%). 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
Medicare (plans)	$9 - $11	87%
Aetna	$10 - $190	97%
Healthcomp_Ihs	$10	97%
Humana	$10 - $194	97%
Tricare	$10	97%
Va	$10	97%
Medicaid / KanCare	$53 - $66	514%
Molina	$53	514%
Regence	$111	1076%
Cigna	$130	1260%
Li	$133	1289%
First_Choice	$162	1570%
Tpsc	$168	1628%
Kaiser	$170	1647%
Premera	$176	1705%
UnitedHealthcare	$184	1783%
Fhpw	$190	1841%
Healthcomp	$194	1880%
Bcchp	$216	2093%
Great_Rivers	$216	2093%
Zenith	$216	2093%

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 $123.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87040.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Astria Sunnyside Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 87040.
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.