CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Mountain West Medical Center

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $3,475
Cash Discount Price: $2,918
vs. Medicare Baseline: 14.26x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Mountain West Medical Center is $3,475. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,918. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 14.26x the Medicare baseline. Located in 2055 North Main Street, Tooele, UT.

Cash / Self-Pay

$2,918

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,475

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: $2,918 (1197%)

Insurance Median: $3,475 (1426%)

Cash: $2,918 (1197% of Medicare)

Ins. Median: $3,475 (1426% 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 1426% of the Medicare baseline (a markup of 1326%). 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	$242 - $934	99%
Select Health McR Adv	$242	99%
Medicare (plans)	$302	124%
Aetna	$1,131	464%
U of Ut-All Plans	$3,161	1297%
Wise/Motivhealth-All Plans	$3,161	1297%
Cigna	$3,448	1414%
Dmba-All Plans	$3,502	1437%
Select Health-All Other Plans	$3,647	1496%
Pehp-All Plans	$3,647	1496%
UnitedHealthcare	$3,745	1536%
Multiplan Primary Network-All Other Plans	$3,842	1576%
Humana	$4,134	1696%
Emi-All Plans	$4,134	1696%
Multiplan Complimentary Network	$4,474	1835%

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 $2,918.
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 Mountain West Medical Center 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.