Neurobehavioral status check
Facility: Pratt Regional Medical Center
Billing Code: 96116 (CPT)
- CPT Billing Code: 96116
- Insurance Median: $268
- Cash Discount Price: $188
- vs. Medicare Baseline: 1.21x 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 |
|---|---|---|
| Christian Health Aid | $201 | 91% |
| UnitedHealthcare | $223 - $320 | 101% |
| Health Partners Of Kansas | $228 | 103% |
| Aetna | $241 | 109% |
| Choicecare | $268 | 121% |
| Celtic Insurance Company | $291 | 132% |
| Healthy Blue | $300 | 136% |
Consumer Guidance & Cost Commentary
For the CPT code 96116, "Neurobehavioral status check," Pratt Regional Medical Center in Pratt, KS, lists a cash price of $188.00, which is lower than the facility's gross charge of $268.00. While the facility's negotiated rates with major payers like UnitedHealthcare and Aetna range from $223 to $300, the cash price may be more cost-effective for patients with high-deductible plans who have not yet met their out-of-pocket maximum. It is important to note that commercial negotiated rates often include administrative overhead and do not reflect the true cost of care; comparing these rates to the Medicare benchmark of $220.60 reveals that the facility's cash price is significantly lower than the standard commercial benchmark, suggesting a potential opportunity for savings if self-pay options are utilized.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency services at in-network facilities, it does not automatically eliminate all unexpected costs for non-emergency procedures. To ensure you receive the best possible rate, you should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling your visit, as these upfront payment incentives can reduce the final amount owed. Additionally, if you do receive a bill, request a full itemized statement to verify that no services were unbundled or double-charged, as over 80% of hospital bills contain errors that can be corrected through a formal written audit dispute.