CMS Price Transparency Data

Neurobehavioral status check

Facility: Portneuf Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $452
Cash Discount Price: $661
vs. Medicare Baseline: 2.05x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Portneuf Medical Center is $452. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $661. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 2.05x the Medicare baseline. Located in 777 Hospital Way, Pocatello, ID.

Cash / Self-Pay

$661

Average discount available for prompt cash payment at this facility.

Insurance Median

$452

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: $661 (300%)

Insurance Median: $452 (205%)

Cash: $661 (300% of Medicare)

Ins. Median: $452 (205% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 205% of the Medicare baseline (a markup of 105%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Black Lung [6055]	$452	205%
Employee Benefit Management Services [2445]	$452 - $661	205%
Healthcare Highways [2210]	$452	205%
Lucent Health [6000]	$452	205%
Moda Health [6100]	$452	205%
Oncology Patient Assistance Programs [2295]	$452	205%
Pending Ssi [1616]	$452	205%
Web Tpa [2115]	$452	205%
Pacific Source Health Plans [2850]	$633	287%
Medishare Christian Care [1645]	$661	300%
Multiplan [1680]	$738	335%
Geha [1415]	$992	450%
UnitedHealthcare	$992	450%

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 $661.
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 Portneuf 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.