CMS Price Transparency Data

Neurobehavioral status check

Facility: Lost Rivers Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $398
Cash Discount Price: $150
vs. Medicare Baseline: 1.80x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Lost Rivers Medical Center is $398. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.80x the Medicare baseline. Located in 551 Highland Drive, Arco, ID.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$398

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: $150 (68%)

Insurance Median: $398 (180%)

Cash: $150 (68% of Medicare)

Ins. Median: $398 (180% 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
Magellan Bh Op Only - All Plans	$86	39%
Tricare	$106	48%
Blue Cross Blue Shield	$168 - $442	76%
First Choice-All Plans	$174	79%
Aetna	$176	80%
Pacificsource Navigator-All Other Plans	$178	81%
Altius Health Plan-All Plans	$181	82%
Regence Blue Shield-All Other Plans	$183	83%
Humana	$187 - $442	85%
Provider Network Of America-All Plans	$397	180%
Select Health Brightpath-All Other Plans	$398	180%
Ihcn Brightpath-All Other Plans	$420	190%
Va Pccc-All Plans	$429	194%
Ihcn Brightpath Mcr Adv	$442	200%
Molina Mcr Adv-All Plans	$442	200%
Pacificsource Mcr Adv	$442	200%
Regence/Brightpth Slhp Mcr	$442	200%
Select Health Mcr Adv	$442	200%
Prime Hlth Mcr Adv	$464	210%

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 $150.
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 Lost Rivers 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.