CMS Price Transparency Data

Physical therapy (gait training)

Facility: Samaritan Pacific Community Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $51
Cash Discount Price: $71
vs. Medicare Baseline: 1.75x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Samaritan Pacific Community Hospital is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.75x the Medicare baseline. Located in 930 Sw Abbey Street, Newport, OR.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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: $71 (244%)

Insurance Median: $51 (175%)

Cash: $71 (244% of Medicare)

Ins. Median: $51 (175% 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
Pacificsource	$25 - $64	86%
Devoted Health	$28 - $35	96%
Healthnet	$28 - $89	96%
Humana	$28 - $90	96%
Samaritan	$28 - $78	96%
Cigna	$29 - $89	100%
Providence	$30 - $89	103%
Ihn	$31	107%
Regence	$32 - $92	110%
Moda	$35 - $87	120%
Aetna	$50 - $87	172%
First Choice	$66	227%

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 $71.
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 Samaritan Pacific Community Hospital 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.