CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: Holy Cross Hospital-Davis

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 71250
  • Insurance Median: $1,622
  • Cash Discount Price: $1,275
  • vs. Medicare Baseline: 15.19x Medicare
The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at Holy Cross Hospital-Davis is $1,622. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,275. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 15.19x the Medicare baseline. Located in 1600 West Antelope Drive, Layton, UT.
Cash / Self-Pay
$1,275

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,622

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: $1,275 (1194%)
Insurance Median: $1,622 (1519%)
Cash: $1,275 (1194% of Medicare)
Ins. Median: $1,622 (1519% 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 1519% of the Medicare baseline (a markup of 1419%). 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
Select Health $62 - $1,567 58%
Medicaid / KanCare $65 61%
Uuhp $65 - $744 61%
Humana $75 70%
Medicare (plans) $75 70%
Employer Direct Healthcare $94 88%
Motivhealth $99 93%
Blue Cross Blue Shield $105 - $1,912 98%
Molina $176 - $1,369 165%
Cigna $243 - $2,550 228%
Centura Employee Plan $337 316%
Pehp $1,361 - $1,849 1274%
Aetna $1,408 - $2,693 1318%
Wise $1,657 - $1,689 1551%
Deseret Mutual Benefit Administrators $1,957 1832%
Multiplan $2,199 - $2,900 2059%
UnitedHealthcare $2,311 - $3,187 2164%
Emi Health $2,773 2596%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1600 West Antelope Drive, Layton, UT 84041
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals