CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Boone County Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $55
Cash Discount Price: $104
vs. Medicare Baseline: 1.89x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) 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 $29.06, this hospital’s rate is 1.89x 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

$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)

Cash / Self-Pay: $104 (358%)

Insurance Median: $55 (189%)

Cash: $104 (358% of Medicare)

Ins. Median: $55 (189% 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.

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	$22 - $122	76%
Iowa Total Care Mcaid - All Plans	$25 - $62	86%
Meridian Mcaid - All Plans	$25 - $61	86%
UnitedHealthcare	$25 - $79	86%
Medicaid / KanCare	$26 - $63	89%
Aetna	$28 - $60	96%
Amerigroup Mcr Adv - All Other Plans	$28 - $56	96%
Choice Care Mcr Adv - All Plans	$28 - $55	96%
Healthsmart Accell Network	$28 - $95	96%
Iowa Hlth Adv - All Plans	$28 - $55	96%
Mt Carmel Hp - All Plans	$28 - $55	96%
Tricare	$28 - $49	96%
Va Ccn-All Plans	$28 - $55	96%
Healthsmart Ppo - All Other Plans	$30 - $108	103%
Health Alliance-All Plans	$33 - $122	114%
Medical Associates Hp-All Plans	$38 - $101	131%
Midlands Choice-All Plans	$38 - $124	131%
Wellmark Hmo	$42 - $106	145%
Wellmark Ppo - All Other Plans	$42 - $116	145%
Health Partners Profee Only - All Plans	$43	148%
Mutually Preferred-All Plans	$117 - $129	403%

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: 97110.

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 97110.
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.