CMS Price Transparency Data

Physical therapy (gait training)

Facility: Jfk University Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $177
Cash Discount Price: $37
vs. Medicare Baseline: 6.09x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Jfk University Medical Center is $177. 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 6.09x the Medicare baseline. Located in 65 James Street, Edison, NJ.

Cash / Self-Pay

$37

Average discount available for prompt cash payment at this facility.

Insurance Median

$177

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: $177 (609%)

Cash: $37 (127% of Medicare)

Ins. Median: $177 (609% 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 609% of the Medicare baseline (a markup of 509%). 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	$34 - $177	117%
UnitedHealthcare	$36 - $558	124%
Horizon	$37 - $194	127%
Amerigroup	$37 - $46	127%
Vaccn	$37	127%
Blue Cross Blue Shield	$37 - $104	127%
Clover	$38	131%
United Community/Americhoice	$39	134%
Seoul Medical Group	$45	155%
Karna	$50	172%
Cigna	$104 - $201	358%
Horizon - Jri@Oumc	$116 - $205	399%
Intergroup	$146	502%
Activecare First McO	$146	502%
Prime Health	$167	575%
Multiplan - PHCS	$178	613%
Brighton Health Plan	$188 - $525	647%
Oxford - Jri@Oumc	$193	664%
Qualcare	$194 - $300	668%
Amerihealth	$198 - $207	681%
Wellcare	$224	771%
Bergen Risk	$291	1001%
Oxford	$414 - $428	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 Jfk 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.