CMS Price Transparency Data

Neurobehavioral status check

Facility: St Luke's Wood River Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $805
Cash Discount Price: $894
vs. Medicare Baseline: 3.65x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at St Luke's Wood River Medical Center is $805. 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 3.65x the Medicare baseline. Located in 100 Hospital Drive, Ketchum, ID.

Cash / Self-Pay

$894

Average discount available for prompt cash payment at this facility.

Insurance Median

$805

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: $805 (365%)

Cash: $894 (405% of Medicare)

Ins. Median: $805 (365% 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 365% of the Medicare baseline (a markup of 265%). 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
Commercial [1028]	$510 - $867	231%
Medicare (plans)	$510 - $520	231%
Veterans Affairs [1056]	$510	231%
Blue Cross Blue Shield	$515 - $764	233%
UnitedHealthcare	$535 - $809	243%
Aetna	$561 - $849	254%
Moda [1055]	$787	357%
Geha [1065]	$809	367%
United Medical Resources [1051]	$809	367%
Cigna	$831	377%
Providence [1022]	$831	377%
Pacificsource [1020]	$840	381%
First Health [1064]	$849 - $867	385%
Webtpa [1071]	$849	385%

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 Wood River 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.