CMS Price Transparency Data

Physical therapy (gait training)

Facility: Astria Sunnyside Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $118
Cash Discount Price: $131
vs. Medicare Baseline: 4.06x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Astria Sunnyside Hospital is $118. 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 $29.06, this hospital’s rate is 4.06x 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

$118

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)

Cash / Self-Pay: $131 (451%)

Insurance Median: $118 (406%)

Cash: $131 (451% of Medicare)

Ins. Median: $118 (406% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $29.06 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 406% of the Medicare baseline (a markup of 306%). 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)	$34 - $83	117%
Aetna	$48 - $290	165%
Healthcomp_Ihs	$48 - $81	165%
Humana	$48 - $297	165%
Medicaid / KanCare	$48 - $101	165%
Molina	$48 - $81	165%
Va	$48 - $81	165%
Tricare	$49 - $82	169%
Regence	$101 - $170	348%
Cigna	$118 - $198	406%
Li	$120 - $203	413%
First_Choice	$147 - $248	506%
Tpsc	$153 - $257	526%
Kaiser	$154 - $259	530%
Premera	$160 - $269	551%
UnitedHealthcare	$167 - $280	575%
Fhpw	$172 - $290	592%
Healthcomp	$176 - $297	606%
Bcchp	$196 - $330	674%
Great_Rivers	$196 - $330	674%
Zenith	$196 - $330	674%

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: 97116.

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 97116.
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.