CMS Price Transparency Data

Neurobehavioral status check

Facility: St Luke's Nampa Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $715
Cash Discount Price: $894
vs. Medicare Baseline: 3.24x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at St Luke's Nampa Medical Center is $715. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $894. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 3.24x the Medicare baseline. Located in 9850 West St Lukes Drive, Nampa, ID.

Cash / Self-Pay

$894

Average discount available for prompt cash payment at this facility.

Insurance Median

$715

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: $894 (405%)

Insurance Median: $715 (324%)

Cash: $894 (405% of Medicare)

Ins. Median: $715 (324% 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 324% of the Medicare baseline (a markup of 224%). 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
Blue Cross Blue Shield	$508 - $951	230%
Commercial [1028]	$508 - $951	230%
Mountain Health Co-Op [1067]	$508 - $581	230%
Pacificsource [1020]	$508 - $670	230%
Select Health [1063]	$508 - $803	230%
Slplan Tap Mc St Lukes Health Plan [1641000001]	$508 - $803	230%
St Lukes Health Plan [1046]	$508 - $803	230%
Aetna	$715 - $805	324%
Cigna	$715	324%
Providence [1022]	$715	324%
Webtpa [1071]	$715 - $760	324%
Geha [1065]	$733	332%
United Medical Resources [1051]	$733	332%
UnitedHealthcare	$733	332%
First Health [1064]	$738 - $760	335%
Moda [1055]	$787	357%
Regence [1005]	$903 - $951	409%
Blue Shield Alt [100401]	$951	431%
Regence Out Of State [1004]	$951	431%

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 $894.
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 St Luke's Nampa 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.