CMS Price Transparency Data

Physical therapy (gait training)

Facility: Jersey Shore University Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $167
Cash Discount Price: $37
vs. Medicare Baseline: 5.75x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Jersey Shore University Medical Center is $167. 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 5.75x the Medicare baseline. Located in 1945 Rte 33, Neptune, NJ.

Cash / Self-Pay

$37

Average discount available for prompt cash payment at this facility.

Insurance Median

$167

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: $167 (575%)

Cash: $37 (127% of Medicare)

Ins. Median: $167 (575% 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 575% of the Medicare baseline (a markup of 475%). 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
UnitedHealthcare	$30 - $367	103%
Aetna	$35 - $164	120%
Amerigroup	$37	127%
Vaccn	$37	127%
Clover	$38	131%
United Community/Americhoice	$39	134%
Blue Cross Blue Shield	$48	165%
Seoul Medical Group	$48	165%
Karna	$49	169%
Horizon	$60 - $209	206%
Qualcare	$162 - $306	557%
Cigna	$167 - $200	575%
Activecare First McO	$178	613%
Multiplan - PHCS	$178	613%
Amerihealth	$183 - $207	630%
Brighton Health Plan	$188	647%
Wellcare	$224	771%
Beacon	$262	902%
Bergen Risk	$291	1001%
Oxford	$561	1930%

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 Jersey Shore University 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.