CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Astria Sunnyside Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $137
Cash Discount Price: $137
vs. Medicare Baseline: 4.19x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Astria Sunnyside Hospital is $137. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $137. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 4.19x the Medicare baseline. Located in 1016 Tacoma Avenue, Sunnyside, WA.

Cash / Self-Pay

$137

Average discount available for prompt cash payment at this facility.

Insurance Median

$137

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.73 (100%)

Cash / Self-Pay: $137 (419%)

Insurance Median: $137 (419%)

Cash: $137 (419% of Medicare)

Ins. Median: $137 (419% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.73 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 419% of the Medicare baseline (a markup of 319%). 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)	$39 - $83	119%
Aetna	$56 - $290	171%
Healthcomp_Ihs	$56 - $81	171%
Humana	$56 - $297	171%
Medicaid / KanCare	$56 - $101	171%
Molina	$56 - $81	171%
Va	$56 - $81	171%
Tricare	$57 - $82	174%
Regence	$118 - $170	361%
Cigna	$137 - $198	419%
Li	$141 - $203	431%
First_Choice	$172 - $248	526%
Tpsc	$179 - $257	547%
Kaiser	$180 - $259	550%
Premera	$186 - $269	568%
UnitedHealthcare	$195 - $280	596%
Fhpw	$202 - $290	617%
Healthcomp	$206 - $297	629%
Bcchp	$229 - $330	700%
Great_Rivers	$229 - $330	700%
Zenith	$229 - $330	700%

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 $137.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97112.

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 97112.
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.