CMS Price Transparency Data

Physical therapy (gait training)

Facility: Ocean Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $158
Cash Discount Price: $37
vs. Medicare Baseline: 5.44x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Ocean Medical Center is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 5.44x the Medicare baseline. Located in 425 Jack Martin Blvd, Brick, NJ.

Cash / Self-Pay

$37

Average discount available for prompt cash payment at this facility.

Insurance Median

$158

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: $37 (127%)

Insurance Median: $158 (544%)

Cash: $37 (127% of Medicare)

Ins. Median: $158 (544% 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 544% of the Medicare baseline (a markup of 444%). 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
Aetna	$27 - $177	93%
Clover	$35 - $38	120%
Amerigroup	$37 - $46	127%
Horizon	$37 - $188	127%
Seoul Medical Group	$37 - $45	127%
Vaccn	$37	127%
United Community/Americhoice	$39	134%
UnitedHealthcare	$44 - $558	151%
Karna	$49 - $50	169%
Blue Cross Blue Shield	$104	358%
Cigna	$104 - $201	358%
Horizon - Jri@Oumc	$116 - $205	399%
Activecare First McO	$146 - $164	502%
Intergroup	$146	502%
Qualcare	$150 - $306	516%
Multiplan - PHCS	$164 - $178	564%
Amerihealth	$166 - $207	571%
Prime Health	$167	575%
Brighton Health Plan	$174 - $525	599%
Oxford - Jri@Oumc	$193	664%
Wellcare	$224	771%
Bergen Risk	$291	1001%
Oxford	$414 - $495	1425%
Brighton Health Plan - Jri@Oumc	$500	1721%

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 $37.
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 Ocean 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.