CMS Price Transparency Data

Neurobehavioral status check

Facility: Lakeside Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $313
Cash Discount Price: $313
vs. Medicare Baseline: 1.42x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Lakeside Medical Center is $313. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $313. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.42x the Medicare baseline. Located in 39200 Hooker Hwy, Belle Glade, FL.

Cash / Self-Pay

$313

Average discount available for prompt cash payment at this facility.

Insurance Median

$313

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: $313 (142%)

Insurance Median: $313 (142%)

Cash: $313 (142% of Medicare)

Ins. Median: $313 (142% 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
Aetna	$69 - $313	31%
Cigna	$100 - $313	45%
Geo	$297	135%
Blue Cross Blue Shield	$313	142%
Care Plus	$313	142%
Humana	$313	142%
Molina	$313 - $328	142%
Simply Healthcare	$313	142%
UnitedHealthcare	$313	142%
Wellpath	$313	142%
Ambetter / Centene	$328	149%
Sunshine	$328	149%
Wellcare	$328	149%
Devoted	$334	151%
Genesys	$344	156%
Prime Health Plan	$344	156%

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 $313.
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 Lakeside Medical Center 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.