Physical therapy (gait training)
Facility: Golden Valley Memorial Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $28
- Cash Discount Price: $97
- vs. Medicare Baseline: 0.96x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | 93% |
| Humana | $27 | 93% |
| UnitedHealthcare | $27 - $46 | 93% |
| Home State Health | $28 | 96% |
| Ambetter / Centene | $32 | 110% |
| Medica | $166 | 571% |
Consumer Guidance & Cost Commentary
If you are paying cash for this physical therapy procedure, you should know that the facility's cash rate of $97 is significantly lower than the state average of $161, offering a potential savings of $64 compared to the general population. While commercial insurance plans typically pay much higher amounts—ranging from $27 to $166 depending on the carrier—the cash price can still be the most economical option for patients with high-deductible plans who have not yet met their coverage thresholds. It is crucial to confirm with Golden Valley Memorial Hospital whether they offer a self-pay or prompt-pay discount, as paying the bill upfront in full often results in a fee reduction that further lowers the final cost.
Broader rate analysis shows that the cash rate of $97 is also well below the facility's gross chargemaster price of $161, highlighting the significant markup often found in hospital billing. Although the facility's negotiated rates for various insurers are higher than the cash price due to administrative costs and contract dynamics, the cash option remains the most transparent and predictable cost for patients. For those concerned about billing errors, it is advisable to request an itemized bill before paying, as over 80% of hospital invoices contain discrepancies such as unbundled codes or services not rendered. Always verify the exact CPT code 97116 on your statement to ensure no balance billing or duplicate charges are included in your final invoice.