Neurobehavioral status check
Facility: Graham County Hospital
Billing Code: 96116 (CPT)
- CPT Billing Code: 96116
- Insurance Median: $48
- Cash Discount Price: $50
- vs. Medicare Baseline: 0.22x 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 |
|---|---|---|
| Medicare (plans) | $38 | 17% |
| UnitedHealthcare | $40 - $142 | 18% |
| Celtic Commercial-All Other Plans | $41 | 19% |
| Wppa (Providers Care)-All Plans | $48 | 22% |
| Medicaid / KanCare | $142 | 64% |
Consumer Guidance & Cost Commentary
For the Neurobehavioral status check (CPT 96116) at Graham County Hospital in Hill City, Kansas, the cash price is $50.00, which matches the facility's median negotiated rate of $48.00 and the state average. While commercial payers like UnitedHealthcare and Medicaid / KanCare have negotiated rates ranging from $40.00 to $142.00, the cash price remains a competitive baseline. Patients with high-deductible plans may find paying the full $50.00 upfront more cost-effective than relying on insurance, as the negotiated rates for some plans exceed the cash price, potentially leading to higher out-of-pocket costs after deductibles are met.
To ensure you are not overcharged, it is important to understand that commercial rates often include administrative overhead and do not reflect the true cost of care, which is better represented by the Medicare benchmark of $220.60. Although the facility is a Critical Access Hospital with government ownership, patients should verify their specific plan's allowed amount before scheduling, as in-network rates vary significantly by carrier. If you receive a bill that appears higher than the cash price, you have the right to request an itemized audit to identify errors such as unbundled codes or services not rendered, and you should ask the hospital about prompt-pay discounts that could further reduce your final balance.