CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Teton Valley Hospital

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $2,038
Cash Discount Price: $1,811
vs. Medicare Baseline: 8.36x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Teton Valley Hospital is $2,038. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,811. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 8.36x the Medicare baseline. Located in 120 East Howard Ave, Driggs, ID.

Cash / Self-Pay

$1,811

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,038

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $1,811 (743%)

Insurance Median: $2,038 (836%)

Cash: $1,811 (743% of Medicare)

Ins. Median: $2,038 (836% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 836% of the Medicare baseline (a markup of 736%). 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
Blue Cross Blue Shield	$72 - $2,196	30%
UnitedHealthcare	$1,041 - $2,151	427%
Aetna	$1,064 - $2,106	436%
Humana	$1,064	436%
Medicare (plans)	$1,064	436%
Prime Health Services-All Other Plans	$1,064	436%
Triwest-All Plans	$1,064	436%
First Choice-All Plans	$2,038	836%
Moda-All Plans	$2,038	836%
Cigna	$2,151	882%
Select Health-All Other Plans	$2,151	882%
St Lukes Brightpath-All Plans	$2,151	882%
Regence Blue Shield-All Other Plans	$2,219	910%

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 $1,811.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74176.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Teton Valley Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74176.
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.