CMS Price Transparency Data

X-ray, lower back

Facility: Teton Valley Hospital

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72110
Insurance Median: $474
Cash Discount Price: $422
vs. Medicare Baseline: 4.44x Medicare

The contracted insurance negotiated median rate for a X-ray, lower back at Teton Valley Hospital is $474. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $422. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.44x the Medicare baseline. Located in 120 East Howard Ave, Driggs, ID.

Cash / Self-Pay

$422

Average discount available for prompt cash payment at this facility.

Insurance Median

$474

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: $422 (395%)

Insurance Median: $474 (444%)

Cash: $422 (395% of Medicare)

Ins. Median: $474 (444% 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 444% of the Medicare baseline (a markup of 344%). 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	$11 - $511	10%
UnitedHealthcare	$242 - $501	227%
Aetna	$248 - $490	232%
Humana	$248	232%
Medicare (plans)	$248	232%
Prime Health Services-All Other Plans	$248	232%
Triwest-All Plans	$248	232%
First Choice-All Plans	$474	444%
Moda-All Plans	$474	444%
Cigna	$501	469%
Select Health-All Other Plans	$501	469%
St Lukes Brightpath-All Plans	$501	469%
Regence Blue Shield-All Other Plans	$516	483%

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 $422.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72110.

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 72110.
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.