CMS Price Transparency Data

Physical therapy (gait training)

Facility: Southern Coos Hospital & Health Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $88
Cash Discount Price: $98
vs. Medicare Baseline: 3.03x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Southern Coos Hospital & Health Center is $88. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $98. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.03x the Medicare baseline. Located in 900 11Th Street Se, Bandon, OR.

Cash / Self-Pay

$98

Average discount available for prompt cash payment at this facility.

Insurance Median

$88

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: $98 (337%)

Insurance Median: $88 (303%)

Cash: $98 (337% of Medicare)

Ins. Median: $88 (303% 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 303% of the Medicare baseline (a markup of 203%). 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
Tricare	$57	196%
Advanced Health - All Plans	$62	213%
Aetna	$65 - $88	224%
Atrio Mcr Adv - Allplans	$65	224%
Confederated Tribes - All Plans	$65	224%
Moda Mcr Adv	$65	224%
Pacific Source Mcr Adv	$65	224%
Cigna	$78	268%
Healthnet - All Plans	$82	282%
Moda Health Plan - All Other Plans	$87	299%
Prov Netwrk Of America - All Plans	$88	303%
Three Rivers - All Plans	$88	303%
UnitedHealthcare	$88	303%
First Choice - All Plans	$90	310%
Blue Cross Blue Shield	$91	313%
Multiplan - All Plans	$91	313%
First Health - All Plans	$93	320%
Pacific Source - All Other Plans	$93	320%
Providence Preferred - All Plans	$93	320%

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 $98.
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 Southern Coos Hospital & Health 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.