CMS Price Transparency Data

Physical therapy (gait training)

Facility: Bayshore Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $154
Cash Discount Price: $37
vs. Medicare Baseline: 5.30x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Bayshore Medical Center is $154. 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 5.30x the Medicare baseline. Located in 727 N Beers St, Holmdel, NJ.

Cash / Self-Pay

$37

Average discount available for prompt cash payment at this facility.

Insurance Median

$154

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: $154 (530%)

Cash: $37 (127% of Medicare)

Ins. Median: $154 (530% 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 530% of the Medicare baseline (a markup of 430%). 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
Clover	$35	120%
Seoul Medical Group	$36	124%
Vaccn	$37	127%
Amerigroup	$37	127%
Aetna	$37 - $151	127%
United Community/Americhoice	$39	134%
UnitedHealthcare	$44 - $359	151%
Horizon	$60 - $167	206%
Qualcare	$150 - $306	516%
Cigna	$154 - $185	530%
Multiplan - PHCS	$164	564%
Amerihealth	$166 - $188	571%
Brighton Health Plan	$174	599%
Wellcare	$224	771%
Bergen Risk	$291	1001%
Oxford	$447	1538%

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 Bayshore 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.