CMS Price Transparency Data

Neurobehavioral status check

Facility: HCA Healthone Presbyterian St Luke's

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $311
Cash Discount Price: $647
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at HCA Healthone Presbyterian St Luke's is $311. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $647. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.41x the Medicare baseline. Located in 1719 E 19Th Ave, Denver, CO.

Cash / Self-Pay

$647

Average discount available for prompt cash payment at this facility.

Insurance Median

$311

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: $647 (293%)

Insurance Median: $311 (141%)

Cash: $647 (293% of Medicare)

Ins. Median: $311 (141% 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
Vail Health	$98	44%
Kaiser	$129 - $168	58%
United	$134 - $291	61%
Cigna	$164 - $414	74%
Aetna	$194 - $342	88%
Bright Health	$194	88%
Emerging Therapy Solutions	$311 - $414	141%
Kaiser National Transplant	$311	141%
Colorado Program For Children With Special Needs	$330	150%
Western Plains Community Health	$421	191%
Multiplan	$453 - $583	205%
Northcare	$453	205%
Physician Health Partners	$453	205%
Blue Cross Blue Shield	$479	217%
Pinnacol Workers Comp	$483	219%
Medical Development International	$518	235%
Prime Health	$583	264%

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 $647.
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 HCA Healthone Presbyterian St Luke's 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.