CMS Price Transparency Data

Neurobehavioral status check

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $148
Cash Discount Price: $136
vs. Medicare Baseline: 0.67x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Iowa Specialty Hospital - Clarion is $148. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $136. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.67x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$136

Average discount available for prompt cash payment at this facility.

Insurance Median

$148

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: $136 (62%)

Insurance Median: $148 (67%)

Cash: $136 (62% of Medicare)

Ins. Median: $148 (67% 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
Tricare	$53 - $70	24%
Triwest Va - All Plans	$53 - $70	24%
Aetna	$83 - $145	38%
Healthscope Stellar-All Plans	$90 - $116	41%
Auxiant Clarion Schools-All Plans	$111 - $183	50%
Health Partners Prestage	$128 - $211	58%
Health Partners Ish-All Other Plans	$137 - $150	62%
UnitedHealthcare	$147 - $162	67%
Wellmark Hmo	$153 - $482	69%
Cigna	$166 - $170	75%
Midlands Choice-All Plans	$166 - $170	75%
Wellmark Ppo - All Other Plans	$177 - $530	80%

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 $136.
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 Iowa Specialty Hospital - Clarion 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.