CMS Price Transparency Data

Neurobehavioral status check

Facility: Cleveland Clinic Indian River Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $109
Cash Discount Price: $436
vs. Medicare Baseline: 0.49x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Cleveland Clinic Indian River Hospital is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $436. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.49x the Medicare baseline. Located in 1000 36Th St, Vero Beach, FL.

Cash / Self-Pay

$436

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

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: $436 (198%)

Insurance Median: $109 (49%)

Cash: $436 (198% of Medicare)

Ins. Median: $109 (49% 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
Magellan	$64 - $88	29%
UnitedHealthcare	$66	30%
Amerihealth	$70	32%
Medicaid / KanCare	$70	32%
Molina	$70	32%
Value Options	$70 - $78	32%
Wellcare	$70 - $313	32%
Blue Cross Blue Shield	$76 - $313	34%
Avmed	$78 - $716	35%
Careplus	$78 - $313	35%
United	$78 - $313	35%
Freedom Health	$82 - $313	37%
Independent Living Systems	$82 - $328	37%
Wellmed	$82 - $313	37%
Clear Spring Health	$84	38%
Cigna	$89 - $114	40%
Aetna	$94 - $603	43%
Carelon Bh Strategies	$313	142%
Humana	$313	142%
Devoted Health	$344	156%
Clarity Health	$436	198%
The Legacy Companies	$436	198%
National Provider Network	$469	213%
Three Rivers	$469	213%
Consociate Health	$502	228%

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 $436.
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 Cleveland Clinic Indian River Hospital 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.