CMS Price Transparency Data

Diagnostic mammogram (both breasts)

Facility: Mountain West Medical Center

Billing Code: 77066 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77066
Insurance Median: $455
Cash Discount Price: $372
vs. Medicare Baseline: 2.90x Medicare

The contracted insurance negotiated median rate for a Diagnostic mammogram (both breasts) at Mountain West Medical Center is $455. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $372. Compared to the federal Medicare reimbursement reference rate of $156.98, this hospital’s rate is 2.90x the Medicare baseline. Located in 2055 North Main Street, Tooele, UT.

Cash / Self-Pay

$372

Average discount available for prompt cash payment at this facility.

Insurance Median

$455

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$156.98

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $156.98 (100%)

Cash / Self-Pay: $372 (237%)

Insurance Median: $455 (290%)

Cash: $372 (237% of Medicare)

Ins. Median: $455 (290% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $156.98 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 290% of the Medicare baseline (a markup of 190%). 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	$120 - $149	76%
Select Health McR Adv	$149	95%
Medicare (plans)	$187	119%
Aetna	$299	190%
Wise/Motivhealth-All Plans	$384 - $423	245%
U of Ut-All Plans	$384 - $423	245%
Cigna	$419 - $461	267%
Dmba-All Plans	$425 - $469	271%
Pehp-All Plans	$443 - $488	282%
Select Health-All Other Plans	$443 - $488	282%
UnitedHealthcare	$455 - $501	290%
Multiplan Primary Network-All Other Plans	$466 - $514	297%
Emi-All Plans	$502 - $553	320%
Humana	$502 - $553	320%
Multiplan Complimentary Network	$543 - $599	346%

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 $372.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 77066.

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 77066.
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.