CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Lost Rivers Medical Center

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $164
Cash Discount Price: $167
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Lost Rivers Medical Center is $164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $167. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.21x the Medicare baseline. Located in 551 Highland Drive, Arco, ID.

Cash / Self-Pay

$167

Average discount available for prompt cash payment at this facility.

Insurance Median

$164

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $167 (123%)

Insurance Median: $164 (121%)

Cash: $167 (123% of Medicare)

Ins. Median: $164 (121% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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
Ihcn Brightpath-All Other Plans	$61 - $420	45%
Pacificsource Navigator-All Other Plans	$61 - $222	45%
Tricare	$73 - $133	54%
Va Pccc-All Plans	$78 - $429	58%
Humana	$81 - $442	60%
Prime Health Svcs-All Other Plans	$81	60%
Select Health Mcr Adv	$81 - $442	60%
UnitedHealthcare	$81	60%
Magellan Bh Op Only - All Plans	$91	67%
Womens Health Check Op/Profee Only-All Plans	$101	74%
Regence/Brightpth Slhp Mcr	$120 - $442	88%
Cigna	$121 - $137	89%
Select Health Brightpath-All Other Plans	$129 - $398	95%
Blue Cross Blue Shield	$131 - $442	97%
Regence Blue Shield-All Other Plans	$144 - $229	106%
Provider Network Of America-All Plans	$145	107%
Aetna	$156 - $220	115%
Altius Health Plan-All Plans	$156 - $227	115%
First Choice-All Plans	$171 - $218	126%
Ihcn Brightpath Mcr Adv	$442	326%
Molina Mcr Adv-All Plans	$442	326%
Pacificsource Mcr Adv	$442	326%
Prime Hlth Mcr Adv	$464	342%

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 $167.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Lost Rivers Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99214.
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.