CMS Price Transparency Data

Trauma team activation

Facility: Mountain West Medical Center

Billing Code: G0390 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0390
Insurance Median: $2,590
Cash Discount Price: $2,159
vs. Medicare Baseline: 1.90x Medicare

The contracted insurance negotiated median rate for a Trauma team activation at Mountain West Medical Center is $2,590. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,159. Compared to the federal Medicare reimbursement reference rate of $1,361.78, this hospital’s rate is 1.90x the Medicare baseline. Located in 2055 North Main Street, Tooele, UT.

Cash / Self-Pay

$2,159

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,590

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,361.78

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,361.78 (100%)

Cash / Self-Pay: $2,159 (159%)

Insurance Median: $2,590 (190%)

Cash: $2,159 (159% of Medicare)

Ins. Median: $2,590 (190% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $1,361.78 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	$945 - $1,350	69%
Select Health McR Adv	$1,350	99%
Medicare (plans)	$1,687	124%
U of Ut-All Plans	$2,089 - $2,590	153%
Wise/Motivhealth-All Plans	$2,089 - $2,590	153%
Cigna	$2,278 - $2,825	167%
Dmba-All Plans	$2,313 - $2,869	170%
Select Health-All Other Plans	$2,410 - $2,988	177%
Aetna	$2,410 - $2,988	177%
Pehp-All Plans	$2,410 - $2,988	177%
UnitedHealthcare	$2,474 - $3,068	182%
Multiplan Primary Network-All Other Plans	$2,538 - $3,147	186%
Emi-All Plans	$2,731 - $3,386	201%
Humana	$2,731 - $3,386	201%
Multiplan Complimentary Network	$2,956 - $3,665	217%

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 $2,159.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0390.

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 G0390.
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.