CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Astria Sunnyside Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $79
Cash Discount Price: $71
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Astria Sunnyside Hospital is $79. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.83x the Medicare baseline. Located in 1016 Tacoma Avenue, Sunnyside, WA.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$79

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $71 (75%)

Insurance Median: $79 (83%)

Cash: $71 (75% of Medicare)

Ins. Median: $79 (83% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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)	$18 - $145	19%
Aetna	$20 - $504	21%
Healthcomp_Ihs	$20 - $141	21%
Humana	$20 - $516	21%
Medicaid / KanCare	$20 - $176	21%
Molina	$20 - $141	21%
Tricare	$20 - $142	21%
Va	$20 - $141	21%
Cigna	$49 - $73	51%
Li	$50 - $352	53%
First_Choice	$62 - $430	65%
Kaiser	$64 - $450	67%
Tpsc	$64 - $447	67%
Premera	$67 - $466	70%
UnitedHealthcare	$70 - $487	74%
Fhpw	$72 - $504	76%
Healthcomp	$74 - $516	78%
Great_Rivers	$82 - $573	86%
Zenith	$82 - $573	86%
Bcchp	$135	142%

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 $71.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

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 99213.
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.