Good Faith Estimate
This Good Faith Estimate is intended to provide you with an estimate of the charges you'll incur at Boulder Sports Physiotherapy. Uninsured and self-pay clients are entitled to Good Faith Estimates as of January 1st, 2022 under the No Surprises Act.
Clinic Fee Structure
Your physical therapy treatment will include an initial evaluation and a combination of treatments that may include manual therapy, therapeutic exercise, gait training, neuromuscular reeducation, dry needling, and functional training. If you have any questions about your upcoming appointment, please don't hesitate to reach out before your visit.
The total cost of your care will include the initial visit, plus any follow-up visits, and will be paid as you go at the time of your appointment. Your first session will be an initial evaluation which costs $185 for 1 hour or $250 for 90 minutes, and follow-up visits are $70-150 each depending on the length of your appointment (i.e. 30 minute follow ups are $80, 60 minute follow ups are $150, etc.) Each session is composed of a combination of the service codes listed below; however, the total cost of your appointment will be the out of pocket rates also listed below. The number of visits will vary based on your particular symptoms and goals, which we will discuss during your evaluation.
Clinic Treatment Codes / Units
Initial Evaluation 97161: $100 - $150
Manual Therapy 97140: $40 - $50
Neuro Re-education 97112: $35 - $40
Therapeutic Exercise 97110: $30 - $40
Gait Training 97116: $30 - $37.50
Therapeutic Activities 97530: $35
Out of Pocket Rates for Physical Therapy Appointments
Initial Evaluation 1 issue $185
Initial Evaluation 2-3 issues $250
Established Patient New Issue $150
Gait Analysis $150
90 minute follow up $230
60 minute follow up $150
45 minute follow up $115
30 minute follow up $80
Dry Needling Only $80
Virtual Physical Therapy Evaluation $80
Virtual Physical Therapy Follow Up $80
Estimated Total Costs
The number of visits required for your plan of care will vary based on your particular symptoms and goals as well as your scheduling needs, which we will discuss during your evaluation. Below is the average cost of care for physical therapy services for for 2 common scenarios, knowing that your total cost may fall above or below this average.
Initial Appointment (Evaluation): $185
Subsequent Appointments (4-5, 1 hour follow ups): $150 x 4 = $600
Total Cost of Plan of Care: $785
Initial Appointment (Evaluation 2-3 issues): $250
Subsequent Appointments (8, 1 hour follow ups): $150 x 8 = $1,200
Total Cost of Plan of Care: $1,450
Disclaimer
This Good Faith Estimate shows the costs of items and services that are reasonably expected based on your health care needs. The estimate is based on information known at the time the estimate was created. It does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur, or if additional treatment is required based on your prognosis and compliance with care. If this happens, federal law allows you to dispute (appeal) the bill.
This Good Faith Estimate is not a contract and does not require you to obtain the services or items from the providers or facility identified in it. You have the right to request another Good Faith Estimate at any time during your course of care.
If the actual billed service charges exceed this estimate by $400 or more, then you (the patient) have the right to dispute the bill via the patient-provider dispute resolution process with the U.S. Department of Health and Human Services (HHS). We ask patients to contact the clinic with any questions or concerns about their physical therapy costs before entering the dispute process. If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.
There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the No Surprises Help Desk at 1-800-985-3059