CMS Price Transparency Data

Neurobehavioral status check

Facility: Adventist Health Ukiah Valley

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $130
Cash Discount Price: $42
vs. Medicare Baseline: 0.59x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Adventist Health Ukiah Valley is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.59x the Medicare baseline. Located in 275 Hospital Drive, Ukiah, CA.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$220.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $220.6 (100%)

Cash / Self-Pay: $42 (19%)

Insurance Median: $130 (59%)

Cash: $42 (19% of Medicare)

Ins. Median: $130 (59% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $220.6 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
Kaiser Medi-Cal	$56 - $84	25%
Medi-Cal	$56 - $84	25%
Blue Cross Blue Shield	$66 - $96	30%
Blue Shield Mcr Adv	$73 - $297	33%
Kaiser Mcr Adv	$73 - $297	33%
Tricare	$73 - $297	33%
Ah Employee Health Plan - All Plans	$80 - $535	36%
Blue Shield Epn-All Other Plans	$86 - $152	39%
Blue Shield Non-Epn	$88 - $161	40%
Aetna	$99 - $151	45%
Cigna	$103 - $177	47%
Western Growers-All Plans	$104 - $129	47%
UnitedHealthcare	$105 - $297	48%
Healthnet-All Plans	$106 - $130	48%
Mendocino Lcc District-All Plans	$126 - $148	57%
Kaiser-All Other Plans	$155 - $182	70%
Foundation For Medical Care-All Plans	$170	77%
Three Rivers-All Plans	$175 - $204	79%
Networks By Design-All Plans	$182	83%
Phcs Multiplan-All Plans	$182	83%
Interplan-All Plans	$186	84%
Beech Street-All Plans	$193	87%
Choice Care-All Plans	$193	87%
Health Mgmt Network-All Plans	$193	87%

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 $42.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 96116.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Ukiah Valley is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 96116.
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.