CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Teton Valley Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $53
Cash Discount Price: $72
vs. Medicare Baseline: 0.56x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Teton Valley Hospital is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 0.56x the Medicare baseline. Located in 120 East Howard Ave, Driggs, ID.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$53

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $72 (76%)

Insurance Median: $53 (56%)

Cash: $72 (76% of Medicare)

Ins. Median: $53 (56% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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
UnitedHealthcare	$25 - $52	26%
Aetna	$26 - $51	27%
Blue Cross Blue Shield	$26 - $125	27%
Humana	$26	27%
Medicare (plans)	$26 - $55	27%
Prime Health Services-All Other Plans	$26 - $55	27%
Triwest-All Plans	$26 - $55	27%
First Choice-All Plans	$50 - $94	53%
Moda-All Plans	$50 - $96	53%
Cigna	$52 - $93	55%
Select Health-All Other Plans	$52 - $80	55%
St Lukes Brightpath-All Plans	$52 - $122	55%
Town And Country-All Plans	$69	72%
Brightpath-All Plans	$80	84%
Pacific Source-All Plans	$88	92%

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 $72.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

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 99213.
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.