CMS Price Transparency Data

Ultrasound, abdomen (limited)

Facility: Mountain West Medical Center

Billing Code: 76705 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76705
  • Insurance Median: $580
  • Cash Discount Price: $731
  • vs. Medicare Baseline: 5.43x Medicare
The contracted insurance negotiated median rate for a Ultrasound, abdomen (limited) at Mountain West Medical Center is $580. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $731. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.43x the Medicare baseline. Located in 2055 North Main Street, Tooele, UT.
Cash / Self-Pay
$731

Average discount available for prompt cash payment at this facility.

Insurance Median
$580

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: $731 (684%)
Insurance Median: $580 (543%)
Cash: $731 (684% of Medicare)
Ins. Median: $580 (543% 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 543% of the Medicare baseline (a markup of 443%). 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.

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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%
U of Ut-All Plans $443 - $1,142 415%
Wise/Motivhealth-All Plans $443 - $1,142 415%
Cigna $483 - $1,245 452%
Dmba-All Plans $491 - $1,264 460%
Select Health-All Other Plans $511 - $1,317 478%
Pehp-All Plans $511 - $1,317 478%
UnitedHealthcare $525 - $1,352 492%
Multiplan Primary Network-All Other Plans $539 - $1,387 505%
Emi-All Plans $580 - $1,493 543%
Humana $580 - $1,493 543%
Multiplan Complimentary Network $627 - $1,616 587%
Aetna $1,071 1003%

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