CMS Price Transparency Data

Ultrasound, pelvis

Facility: Teton Valley Hospital

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $680
Cash Discount Price: $604
vs. Medicare Baseline: 6.37x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at Teton Valley Hospital is $680. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $604. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.37x the Medicare baseline. Located in 120 East Howard Ave, Driggs, ID.

Cash / Self-Pay

$604

Average discount available for prompt cash payment at this facility.

Insurance Median

$680

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $604 (565%)

Insurance Median: $680 (637%)

Cash: $604 (565% of Medicare)

Ins. Median: $680 (637% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 637% of the Medicare baseline (a markup of 537%). 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	$29 - $732	27%
UnitedHealthcare	$347 - $717	325%
Aetna	$355 - $702	332%
Humana	$355	332%
Medicare (plans)	$355	332%
Prime Health Services-All Other Plans	$355	332%
Triwest-All Plans	$355	332%
First Choice-All Plans	$680	637%
Moda-All Plans	$680	637%
Cigna	$717	671%
Select Health-All Other Plans	$717	671%
St Lukes Brightpath-All Plans	$717	671%
Regence Blue Shield-All Other Plans	$740	693%

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 $604.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 76856.

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 76856.
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.