CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Portneuf Medical Center

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $125
Cash Discount Price: $91
vs. Medicare Baseline: 4.30x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Portneuf Medical Center is $125. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $91. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.30x the Medicare baseline. Located in 777 Hospital Way, Pocatello, ID.

Cash / Self-Pay

$91

Average discount available for prompt cash payment at this facility.

Insurance Median

$125

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: $91 (313%)

Insurance Median: $125 (430%)

Cash: $91 (313% of Medicare)

Ins. Median: $125 (430% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 430% of the Medicare baseline (a markup of 330%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Bannock County Jail [6050]	$26	89%
Department Of Corrections [1340]	$26	89%
Medicaid / KanCare	$26	89%
Pending County Rca [3910]	$26	89%
UnitedHealthcare	$26 - $136	89%
Aetna	$31 - $128	107%
Healthscope Benefits [2290]	$31	107%
Black Lung [6055]	$62	213%
Employee Benefit Management Services [2445]	$62 - $91	213%
Healthcare Highways [2210]	$62 - $143	213%
Lucent Health [6000]	$62	213%
Moda Health [6100]	$62	213%
Oncology Patient Assistance Programs [2295]	$62	213%
Pending Ssi [1616]	$62	213%
Web Tpa [2115]	$62	213%
Pacific Source Health Plans [2850]	$87	299%
Liberty Health Share Lhs/Medcost Solutions Llc [2400]	$91	313%
Medishare Christian Care [1645]	$91	313%
Multiplan [1680]	$101 - $143	348%
Worker'S Comp [2125]	$110 - $113	379%
Enablecomp [1350]	$113	389%
Transamerican Life [1990]	$113	389%
First Health [1375]	$125	430%
Mailhandlers [1595]	$128	440%
Selecthealth [3740]	$128 - $136	440%
Cigna	$133	458%
Geha [1415]	$136	468%
Humana	$136	468%
Administrative Concepts [1005]	$143	492%
Healthfirst [2395]	$143	492%
Healthnet [1495]	$143	492%
Hometown Health [2155]	$143	492%
Mayo Clinic Health Solutions [2280]	$143	492%
Meritain Health [1655]	$143	492%
Mutual Of Omaha [1685]	$143	492%
National Association Of Letter Carriers [1695]	$143	492%
New Era Life Insurance Company [1705]	$143	492%
Pan American Life Insurance Co [1770]	$143	492%
Pba [1775]	$143	492%
Phcs [1780]	$143	492%
Planned Administrators Inc [2360]	$143	492%
Trustmark [2030]	$143	492%
Ut Id Teamsters [3760]	$143	492%

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 $91.
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 Portneuf Medical Center 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.