CMS Price Transparency Data

Mental health services (assessment)

Facility: Samaritan Lebanon Community Hospital

Billing Code: H0031 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: H0031
Insurance Median: $114
Cash Discount Price: $122
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Mental health services (assessment) at Samaritan Lebanon Community Hospital is $114. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $122. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 525 N Santiam Highway, Lebanon, OR.

Cash / Self-Pay

$122

Average discount available for prompt cash payment at this facility.

Insurance Median

$114

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
Ihn	$76 - $146	N/A
Samaritan	$76 - $129	N/A
Healthnet	$91 - $122	N/A
Moda	$91 - $122	N/A
Providence	$91 - $122	N/A
Humana	$106	N/A
Pacificsource	$106 - $114	N/A
First Choice	$122	N/A
Cigna	$129	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 $122.
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 Samaritan Lebanon Community Hospital 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.