CMS Price Transparency Data

Mental health services (assessment)

Facility: Holy Cross Hospital-Davis

Billing Code: H0031 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: H0031
Insurance Median: $421
Cash Discount Price: $311
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Mental health services (assessment) at Holy Cross Hospital-Davis is $421. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $311. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 1600 West Antelope Drive, Layton, UT.

Cash / Self-Pay

$311

Average discount available for prompt cash payment at this facility.

Insurance Median

$421

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
Centura Employee Plan	$166	N/A
Cigna	$278 - $621	N/A
Blue Cross Blue Shield	$289 - $482	N/A
Pehp	$332 - $450	N/A
Molina	$333	N/A
Aetna	$343 - $656	N/A
Select Health	$382	N/A
Uuhp	$383 - $421	N/A
Wise	$404 - $412	N/A
Deseret Mutual Benefit Administrators	$477	N/A
Multiplan	$536 - $707	N/A
UnitedHealthcare	$563 - $776	N/A
Emi Health	$676	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 $311.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: H0031.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Holy Cross Hospital-Davis is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code H0031.
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.