CMS Price Transparency Data

Prosthetic fitting and training

Facility: Astria Sunnyside Hospital

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $110
Cash Discount Price: $126
vs. Medicare Baseline: 2.72x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Astria Sunnyside Hospital is $110. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $126. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.72x the Medicare baseline. Located in 1016 Tacoma Avenue, Sunnyside, WA.

Cash / Self-Pay

$126

Average discount available for prompt cash payment at this facility.

Insurance Median

$110

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$40.41

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $40.41 (100%)

Cash / Self-Pay: $126 (312%)

Insurance Median: $110 (272%)

Cash: $126 (312% of Medicare)

Ins. Median: $110 (272% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $40.41 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 272% of the Medicare baseline (a markup of 172%). 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)	$40 - $81	99%
Aetna	$44 - $281	109%
Healthcomp_Ihs	$44 - $78	109%
Humana	$44 - $287	109%
Medicaid / KanCare	$44 - $98	109%
Molina	$44 - $78	109%
Tricare	$44 - $79	109%
Va	$44 - $78	109%
Regence	$92 - $164	228%
Cigna	$107 - $191	265%
Li	$110 - $196	272%
First_Choice	$134 - $239	332%
Tpsc	$140 - $249	346%
Kaiser	$141 - $250	349%
Premera	$146 - $260	361%
UnitedHealthcare	$152 - $271	376%
Fhpw	$158 - $281	391%
Healthcomp	$161 - $287	398%
Bcchp	$179 - $319	443%
Great_Rivers	$179 - $319	443%
Zenith	$179 - $319	443%

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 $126.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97761.

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 97761.
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.