CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Astria Sunnyside Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $96
Cash Discount Price: $128
vs. Medicare Baseline: 3.46x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Astria Sunnyside Hospital is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $128. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 3.46x the Medicare baseline. Located in 1016 Tacoma Avenue, Sunnyside, WA.

Cash / Self-Pay

$128

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$27.72

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $27.72 (100%)

Cash / Self-Pay: $128 (462%)

Insurance Median: $96 (346%)

Cash: $128 (462% of Medicare)

Ins. Median: $96 (346% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $27.72 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 346% of the Medicare baseline (a markup of 246%). 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)	$32 - $71	115%
Aetna	$38 - $248	137%
Healthcomp_Ihs	$38 - $69	137%
Humana	$38 - $254	137%
Medicaid / KanCare	$38 - $86	137%
Molina	$38 - $69	137%
Va	$38 - $69	137%
Tricare	$39 - $70	141%
Regence	$81 - $145	292%
Cigna	$94 - $169	339%
Li	$96 - $173	346%
First_Choice	$118 - $212	426%
Tpsc	$122 - $220	440%
Kaiser	$123 - $221	444%
Premera	$128 - $230	462%
UnitedHealthcare	$133 - $240	480%
Fhpw	$138 - $248	498%
Healthcomp	$141 - $254	509%
Bcchp	$157 - $282	566%
Great_Rivers	$157 - $282	566%
Zenith	$157 - $282	566%

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 $128.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97140.

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 97140.
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.