CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Lost Rivers Medical Center

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $61
Cash Discount Price: $60
vs. Medicare Baseline: 2.10x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Lost Rivers Medical Center is $61. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $60. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.10x the Medicare baseline. Located in 551 Highland Drive, Arco, ID.

Cash / Self-Pay

$60

Average discount available for prompt cash payment at this facility.

Insurance Median

$61

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: $60 (206%)

Insurance Median: $61 (210%)

Cash: $60 (206% of Medicare)

Ins. Median: $61 (210% 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 210% of the Medicare baseline (a markup of 110%). 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
Tricare	$35 - $51	120%
Provider Network Of America-All Plans	$50	172%
Select Health Brightpath-All Other Plans	$51 - $398	175%
Ihcn Brightpath-All Other Plans	$54 - $420	186%
Blue Cross Blue Shield	$55 - $442	189%
Va Pccc-All Plans	$55 - $429	189%
Aetna	$57 - $85	196%
First Choice-All Plans	$57 - $84	196%
Humana	$57 - $442	196%
Ihcn Brightpath Mcr Adv	$57 - $442	196%
Molina Mcr Adv-All Plans	$57 - $442	196%
Pacificsource Mcr Adv	$57 - $442	196%
Regence/Brightpth Slhp Mcr	$57 - $442	196%
Select Health Mcr Adv	$57 - $442	196%
Pacificsource Navigator-All Other Plans	$58 - $86	200%
Altius Health Plan-All Plans	$59 - $87	203%
Prime Hlth Mcr Adv	$60 - $464	206%
Regence Blue Shield-All Other Plans	$60 - $88	206%
Cigna	$84	289%
UnitedHealthcare	$86	296%

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 $60.
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 Lost Rivers 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.