CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Boone County Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $55
Cash Discount Price: $104
vs. Medicare Baseline: 1.68x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Boone County Hospital is $55. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.68x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$104

Average discount available for prompt cash payment at this facility.

Insurance Median

$55

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.73 (100%)

Cash / Self-Pay: $104 (318%)

Insurance Median: $55 (168%)

Cash: $104 (318% of Medicare)

Ins. Median: $55 (168% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.73 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.

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
Humana	$25 - $122	76%
Iowa Total Care Mcaid - All Plans	$26 - $62	79%
Meridian Mcaid - All Plans	$26 - $61	79%
Medicaid / KanCare	$27 - $63	82%
UnitedHealthcare	$29 - $79	89%
Choice Care Mcr Adv - All Plans	$31 - $55	95%
Iowa Hlth Adv - All Plans	$31 - $55	95%
Mt Carmel Hp - All Plans	$31 - $55	95%
Tricare	$31 - $49	95%
Va Ccn-All Plans	$31 - $55	95%
Aetna	$32 - $60	98%
Amerigroup Mcr Adv - All Other Plans	$32 - $56	98%
Healthsmart Accell Network	$32 - $95	98%
Healthsmart Ppo - All Other Plans	$33 - $108	101%
Health Alliance-All Plans	$37 - $122	113%
Medical Associates Hp-All Plans	$42 - $101	128%
Health Partners Profee Only - All Plans	$44	134%
Midlands Choice-All Plans	$44 - $124	134%
Wellmark Hmo	$49 - $106	150%
Wellmark Ppo - All Other Plans	$49 - $116	150%
Mutually Preferred-All Plans	$117 - $129	357%

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 $104.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97112.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Boone County Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97112.
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.