CMS Price Transparency Data

Physical therapy (gait training)

Facility: Hillsboro Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $33
Cash Discount Price: $116
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Hillsboro Medical Center is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $116. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.14x the Medicare baseline. Located in 335 Se 8Th Avenue, Hillsboro, OR.

Cash / Self-Pay

$116

Average discount available for prompt cash payment at this facility.

Insurance Median

$33

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: $116 (399%)

Insurance Median: $33 (114%)

Cash: $116 (399% of Medicare)

Ins. Median: $33 (114% 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.

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
Care Oregon	$24 - $36	83%
Intercommunity Health Network	$24	83%
Medicare (plans)	$24 - $36	83%
Kaiser Foundation Hospitals	$25 - $90	86%
Pacific Source	$25 - $114	86%
Community Health Plan Of Washington	$31 - $178	107%
Providence Health Plan	$31 - $178	107%
Samaritan Health Plan	$31	107%
Trillium	$31	107%
Humana	$32 - $33	110%
Aetna	$33 - $160	114%
UnitedHealthcare	$33 - $49	114%
Moda	$34 - $111	117%
Health Net Health Plan Of Oregon, Inc.	$35 - $117	120%
Blue Cross Blue Shield	$97	334%
Tuality Health	$116	399%
First Choice	$142	489%
Coventry First Health	$151	520%
Cigna	$178	613%
Molina Exchange	$178	613%

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 $116.
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 Hillsboro Medical Center 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.