CMS Price Transparency Data

Hospital observation (per hour)

Facility: Mountain West Medical Center

Billing Code: G0378 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0378
Insurance Median: $210
Cash Discount Price: $185
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Hospital observation (per hour) at Mountain West Medical Center is $210. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $185. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 2055 North Main Street, Tooele, UT.

Cash / Self-Pay

$185

Average discount available for prompt cash payment at this facility.

Insurance Median

$210

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

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
U of Ut-All Plans	$28 - $635	N/A
Wise/Motivhealth-All Plans	$28 - $635	N/A
Cigna	$30 - $692	N/A
Dmba-All Plans	$31 - $703	N/A
Aetna	$32 - $733	N/A
Blue Cross Blue Shield	$32 - $739	N/A
Select Health-All Other Plans	$32 - $733	N/A
Pehp-All Plans	$32 - $733	N/A
UnitedHealthcare	$33 - $752	N/A
Multiplan Primary Network-All Other Plans	$34 - $772	N/A
Humana	$36 - $830	N/A
Emi-All Plans	$36 - $830	N/A
Multiplan Complimentary Network	$39 - $899	N/A

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 $185.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0378.

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 G0378.
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.