CMS Price Transparency Data

X-ray, pelvis

Facility: Mountain West Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72170
  • Insurance Median: $459
  • Cash Discount Price: $371
  • vs. Medicare Baseline: 4.30x Medicare
The contracted insurance negotiated median rate for a X-ray, pelvis at Mountain West Medical Center is $459. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $371. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 4.30x the Medicare baseline. Located in 2055 North Main Street, Tooele, UT.
Cash / Self-Pay
$371

Average discount available for prompt cash payment at this facility.

Insurance Median
$459

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: $371 (347%)
Insurance Median: $459 (430%)
Cash: $371 (347% of Medicare)
Ins. Median: $459 (430% 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 430% of the Medicare baseline (a markup of 330%). 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 $106 - $456 99%
Select Health McR Adv $106 99%
Medicare (plans) $132 124%
Wise/Motivhealth-All Plans $402 376%
U of Ut-All Plans $402 376%
Cigna $438 410%
Dmba-All Plans $445 417%
Select Health-All Other Plans $463 433%
Aetna $463 433%
Pehp-All Plans $463 433%
UnitedHealthcare $476 446%
Multiplan Primary Network-All Other Plans $488 457%
Humana $525 492%
Emi-All Plans $525 492%
Multiplan Complimentary Network $568 532%

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