CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Astria Sunnyside Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $124
Cash Discount Price: $131
vs. Medicare Baseline: 3.54x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Astria Sunnyside Hospital is $124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $131. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.54x the Medicare baseline. Located in 1016 Tacoma Avenue, Sunnyside, WA.

Cash / Self-Pay

$131

Average discount available for prompt cash payment at this facility.

Insurance Median

$124

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $131 (374%)

Insurance Median: $124 (354%)

Cash: $131 (374% of Medicare)

Ins. Median: $124 (354% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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 354% of the Medicare baseline (a markup of 254%). 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)	$43 - $83	123%
Aetna	$51 - $290	145%
Healthcomp_Ihs	$51 - $81	145%
Humana	$51 - $297	145%
Medicaid / KanCare	$51 - $101	145%
Molina	$51 - $81	145%
Tricare	$51 - $82	145%
Va	$51 - $81	145%
Regence	$106 - $170	302%
Cigna	$124 - $198	354%
Li	$126 - $203	359%
First_Choice	$154 - $248	439%
Tpsc	$161 - $257	459%
Kaiser	$162 - $259	462%
Premera	$168 - $269	479%
UnitedHealthcare	$175 - $280	499%
Fhpw	$181 - $290	516%
Healthcomp	$185 - $297	528%
Bcchp	$206 - $330	587%
Great_Rivers	$206 - $330	587%
Zenith	$206 - $330	587%

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 $131.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

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 97530.
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.