CMS Price Transparency Data

Electrical stimulation therapy

Facility: Mountain West Medical Center

Billing Code: G0283 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0283
Insurance Median: $95
Cash Discount Price: $77
vs. Medicare Baseline: 7.49x Medicare

The contracted insurance negotiated median rate for a Electrical stimulation therapy at Mountain West Medical Center is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $77. Compared to the federal Medicare reimbursement reference rate of $12.69, this hospital’s rate is 7.49x the Medicare baseline. Located in 2055 North Main Street, Tooele, UT.

Cash / Self-Pay

$77

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$12.69

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $12.69 (100%)

Cash / Self-Pay: $77 (607%)

Insurance Median: $95 (749%)

Cash: $77 (607% of Medicare)

Ins. Median: $95 (749% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $12.69 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 749% of the Medicare baseline (a markup of 649%). 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
Select Health McR Adv	$12	95%
Blue Cross Blue Shield	$12 - $14	95%
Medicare (plans)	$15	118%
Wise/Motivhealth-All Plans	$82 - $85	646%
U of Ut-All Plans	$82 - $85	646%
Cigna	$90 - $93	709%
Dmba-All Plans	$91 - $95	717%
Select Health-All Other Plans	$95 - $99	749%
Aetna	$95 - $99	749%
Pehp-All Plans	$95 - $99	749%
UnitedHealthcare	$97 - $101	764%
Multiplan Primary Network-All Other Plans	$100 - $104	788%
Emi-All Plans	$107 - $112	843%
Humana	$107 - $112	843%
Multiplan Complimentary Network	$116 - $121	914%

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 $77.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0283.

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 HCPCS code G0283.
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.