Neurobehavioral status check
Facility: St. Catherine Hospital - Garden City
Billing Code: 96116 (CPT)
- CPT Billing Code: 96116
- Insurance Median: $75
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.34x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Kansas Health | $73 | 33% |
| Aetna | $73 - $76 | 33% |
| UnitedHealthcare | $73 - $76 | 33% |
| Humana | $73 - $76 | 33% |
| Kaiser | $73 - $76 | 33% |
| Cigna | $73 - $76 | 33% |
| Medicare (plans) | $73 - $76 | 33% |
| Blue Cross Blue Shield | $73 - $509 | 33% |
| Innovage | $76 | 34% |
| Devoted Health | $76 | 34% |
Consumer Guidance & Cost Commentary
For the CPT code 96116, "Neurobehavioral status check," St. Catherine Hospital - Garden City in Garden City, KS, has a median negotiated rate of $75.00 across ten payers. This rate is notably higher than the state average of $73.00, which is the lowest rate observed among Kansas payers for this service. While most commercial plans and Medicare plans fall within the $73 to $76 range, Blue Cross Blue Shield offers a wider spread from $73 to $509, and Kaiser provides an integrated-system internal rate that is not a typical negotiated rate. Patients should be aware that cash-pay options are not listed for this specific code, so inquiring about self-pay or prompt-pay discounts directly with the hospital is essential to determine if paying out-of-pocket could result in lower costs, particularly for those with high-deductible plans where insurance negotiated rates might exceed cash prices.
The facility, a voluntary non-profit church-owned acute care hospital, uses a Medicare benchmark of $220.60 as its pricing baseline. Under Medicare benchmarking principles, commercial negotiated rates often average between 200% and 300% of Medicare rates, though fair pricing is typically defined as 120% to 150%. In this case, the $75.00 negotiated rate represents a significant markup over the Medicare amount, reflecting the administrative costs and contract dynamics inherent in commercial insurance. Consumers should avoid accepting summary bills as final invoices and instead request a detailed, itemized audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain