CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Astria Sunnyside Hospital

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $107
Cash Discount Price: $146
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Astria Sunnyside Hospital is $107. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $146. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 0.91x the Medicare baseline. Located in 1016 Tacoma Avenue, Sunnyside, WA.

Cash / Self-Pay

$146

Average discount available for prompt cash payment at this facility.

Insurance Median

$107

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: $146 (124%)

Insurance Median: $107 (91%)

Cash: $146 (124% of Medicare)

Ins. Median: $107 (91% 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.

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)	$27 - $241	23%
Aetna	$30 - $840	26%
Healthcomp_Ihs	$30 - $234	26%
Humana	$30 - $859	26%
Medicaid / KanCare	$30 - $292	26%
Molina	$30 - $234	26%
Tricare	$30 - $236	26%
Va	$30 - $234	26%
Cigna	$73 - $82	62%
Li	$75 - $586	64%
First_Choice	$92 - $716	78%
Tpsc	$95 - $744	81%
Kaiser	$96 - $749	82%
Premera	$99 - $777	84%
UnitedHealthcare	$104 - $811	88%
Fhpw	$107 - $840	91%
Healthcomp	$110 - $859	94%
Great_Rivers	$122 - $954	104%
Zenith	$122 - $954	104%
Bcchp	$135	115%

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 $146.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

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 99203.
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.