Physical therapy (therapeutic exercise)
Facility: Golden Valley Memorial Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $28
- Cash Discount Price: $95
- 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
For patients considering physical therapy services at Golden Valley Memorial Hospital, the most important factor to know upfront is that paying cash directly can often result in a lower total cost than using insurance, particularly if your plan has a high deductible. The hospital's cash rate for this service is $95, which is significantly lower than the median negotiated rate of $28 paid by most insurance carriers. While commercial rates are often higher due to administrative overhead and contract structures, paying out-of-pocket allows you to bypass these inflated fees entirely. If you are self-paying, it is advisable to explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, as these programs can further reduce the final amount owed.
In the broader context of pricing, the hospital's cash rate of $95 is notably higher than the state of Missouri average of $29 and the county average of $21. This elevated cost relative to regional averages may be attributed to the facility's classification as a Government-owned Acute Care Hospital, which often operates under different cost structures than private providers. However, when comparing the cash price against the Medicare benchmark rate of $29.06, the cash charge remains well above the federal baseline, suggesting a markup typical of commercial pricing models. It is crucial to understand that while the cash rate exceeds the Medicare benchmark, it remains a fixed, predictable price that avoids the potential for balance billing or unexpected secondary charges associated with insurance claims.