CMS Price Transparency Data

Injection procedure for pain management

Facility: Mountain West Medical Center

Billing Code: G0260 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0260
Insurance Median: $1,013
Cash Discount Price: $827
vs. Medicare Baseline: 1.40x Medicare

The contracted insurance negotiated median rate for a Injection procedure for pain management at Mountain West Medical Center is $1,013. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $827. Compared to the federal Medicare reimbursement reference rate of $721.17, this hospital’s rate is 1.40x the Medicare baseline. Located in 2055 North Main Street, Tooele, UT.

Cash / Self-Pay

$827

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,013

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$721.17

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $721.17 (100%)

Cash / Self-Pay: $827 (115%)

Insurance Median: $1,013 (140%)

Cash: $827 (115% of Medicare)

Ins. Median: $1,013 (140% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $721.17 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.

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	$599 - $715	83%
Select Health McR Adv	$715	99%
Medicare (plans)	$893	124%
Wise/Motivhealth-All Plans	$896	124%
U of Ut-All Plans	$896	124%
Cigna	$977	135%
Dmba-All Plans	$992	138%
Aetna	$1,034	143%
Select Health-All Other Plans	$1,034	143%
Pehp-All Plans	$1,034	143%
UnitedHealthcare	$1,061	147%
Multiplan Primary Network-All Other Plans	$1,089	151%
Emi-All Plans	$1,172	163%
Humana	$1,172	163%
Multiplan Complimentary Network	$1,268	176%

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 $827.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0260.

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 G0260.
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.