CMS Price Transparency Data

CT scan, pelvis

Facility: Mountain West Medical Center

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $1,780
Cash Discount Price: $1,495
vs. Medicare Baseline: 16.67x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Mountain West Medical Center is $1,780. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,495. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 16.67x the Medicare baseline. Located in 2055 North Main Street, Tooele, UT.

Cash / Self-Pay

$1,495

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,780

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: $1,495 (1400%)

Insurance Median: $1,780 (1667%)

Cash: $1,495 (1400% of Medicare)

Ins. Median: $1,780 (1667% 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 1667% of the Medicare baseline (a markup of 1567%). 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	$106 - $456	99%
Select Health McR Adv	$106	99%
Medicare (plans)	$132	124%
Aetna	$1,131	1059%
Wise/Motivhealth-All Plans	$1,619	1516%
U of Ut-All Plans	$1,619	1516%
Cigna	$1,766	1653%
Dmba-All Plans	$1,794	1680%
Pehp-All Plans	$1,868	1749%
Select Health-All Other Plans	$1,868	1749%
UnitedHealthcare	$1,918	1796%
Multiplan Primary Network-All Other Plans	$1,968	1843%
Emi-All Plans	$2,118	1983%
Humana	$2,118	1983%
Multiplan Complimentary Network	$2,292	2146%

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 $1,495.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72192.

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 72192.
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.