Neurobehavioral status check
Facility: Cloud County Health Center
Billing Code: 96116 (CPT)
- CPT Billing Code: 96116
- Insurance Median: $152
- Cash Discount Price: $152
- vs. Medicare Baseline: 0.69x 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 |
|---|---|---|
| Mpi-All Plans | $99 | 45% |
| Pponext-All Plans | $206 | 93% |
Consumer Guidance & Cost Commentary
For the CPT code 96116, "Neurobehavioral status check," Cloud County Health Center in Concordia, KS, lists a cash median price of $152.00 and a median negotiated rate of $152.00. This cash price is notably lower than the facility's gross charge of $217.00, offering a potential savings of $65.00 for patients paying out-of-pocket. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the data indicates that the negotiated rate for this specific service matches the cash price exactly, meaning patients with high-deductible plans may find paying cash directly more cost-effective than relying on insurance, which often incurs administrative overhead that inflates the baseline price.
When evaluating this charge against federal benchmarks, the Medicare amount for this procedure is $220.60. The facility's cash rate of $152.00 represents approximately 69% of the Medicare benchmark (0.7), which falls well below the typical commercial negotiated range of 120% to 150% of Medicare, suggesting a highly competitive pricing model. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details before scheduling. Additionally, patients are encouraged to ask the hospital directly about "self-pay" or "prompt-pay" discounts, as paying the bill in full upfront can sometimes yield further reductions beyond the listed cash median.