CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Mountain West Medical Center

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 70553
  • Insurance Median: $3,220
  • Cash Discount Price: $2,704
  • vs. Medicare Baseline: 9.03x Medicare
The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Mountain West Medical Center is $3,220. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,704. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 9.03x the Medicare baseline. Located in 2055 North Main Street, Tooele, UT.
Cash / Self-Pay
$2,704

Average discount available for prompt cash payment at this facility.

Insurance Median
$3,220

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)
Cash / Self-Pay: $2,704 (759%)
Insurance Median: $3,220 (903%)
Cash: $2,704 (759% of Medicare)
Ins. Median: $3,220 (903% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 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 903% of the Medicare baseline (a markup of 803%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 $353 - $1,563 99%
Select Health McR Adv $353 99%
Medicare (plans) $442 124%
Aetna $1,531 430%
Wise/Motivhealth-All Plans $2,929 822%
U of Ut-All Plans $2,929 822%
Cigna $3,195 896%
Dmba-All Plans $3,245 910%
Select Health-All Other Plans $3,380 948%
Pehp-All Plans $3,380 948%
UnitedHealthcare $3,470 974%
Multiplan Primary Network-All Other Plans $3,560 999%
Emi-All Plans $3,831 1075%
Humana $3,831 1075%
Multiplan Complimentary Network $4,146 1163%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 2055 North Main Street, Tooele, UT 84074
  • CMS Rating: ★★★★☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals