CMS Price Transparency Data
Neurobehavioral status check
Facility: Trinity Health Muskegon Hospital
Billing Code: 96116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 96116
- Insurance Median: $209
- Cash Discount Price: $181
- vs. Medicare Baseline: 0.95x Medicare
The contracted insurance negotiated median rate for a Neurobehavioral status check at Trinity Health Muskegon Hospital is $209. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $181. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.95x the Medicare baseline. Located in 1500 E Sherman Blvd, Muskegon, MI.
Cash / Self-Pay
$181
Average discount available for prompt cash payment at this facility.
Insurance Median
$209
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: $181 (82%)
Insurance Median: $209 (95%)
Cash: $181 (82% of Medicare)
Ins. Median: $209 (95% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $117 - $189 | 53% |
| Bcn Domestic | $136 | 62% |
| Blue Benefit Administrators Of Massachusetts | $136 | 62% |
| Blue Care Network | $136 | 62% |
| Blue Cross Blue Shield | $136 | 62% |
| Blue Distinction Transplant | $136 | 62% |
| Blue Shield - Ca | $136 | 62% |
| Blue Shield - Id (Regence) | $136 | 62% |
| Blue Shield - Ny Highmark Northeastern | $136 | 62% |
| Blue Shield - Ny Highmark Western | $136 | 62% |
| Blue Shield - Pa (Highmark) | $136 | 62% |
| Blue Shield - Wa (Regence) | $136 | 62% |
| Health Choices | $136 - $220 | 62% |
| Kaiser Domestic | $136 | 62% |
| Acs Benefit Services | $145 | 66% |
| Allied Benefit Systems | $145 | 66% |
| Claimchoice Adminstrators | $145 | 66% |
| Consociate | $145 | 66% |
| Cypress Benefit Administrators | $145 | 66% |
| Forest County Potawatomi | $145 | 66% |
| Health Smart | $145 | 66% |
| Healthgram | $145 | 66% |
| Healthscope | $145 | 66% |
| Preferred One | $145 | 66% |
| Secureone Preferred United Plans | $145 | 66% |
| Sisco Benefits | $145 | 66% |
| The Health Plan | $145 | 66% |
| Trustmark Small Business Benefits | $145 | 66% |
| Unified Group Services | $145 | 66% |
| Webtpa | $145 | 66% |
| Asr Health Benefits | $148 | 67% |
| Hap | $148 - $221 | 67% |
| Wc Accident Fund | $149 | 68% |
| Wc Advantage | $149 | 68% |
| Wc Aig | $149 | 68% |
| Wc Allied | $149 | 68% |
| Wc Amerisure | $149 | 68% |
| Wc Amtrust | $149 | 68% |
| Wc Asu Risk Mgt | $149 | 68% |
| Wc Berkley Admin | $149 | 68% |
| Wc Broadspire | $149 | 68% |
| Wc Bunch & Associates | $149 | 68% |
| Wc Ccmsi | $149 | 68% |
| Wc Emc Insurance Company | $149 | 68% |
| Wc Esis | $149 | 68% |
| Wc Fcci | $149 | 68% |
| Wc Federated | $149 | 68% |
| Wc Gallagher Bassett | $149 | 68% |
| Wc Genex Care For Ohio | $149 | 68% |
| Wc Guard Insurance Company | $149 | 68% |
| Wc Hartford | $149 | 68% |
| Wc Liberty Mutual | $149 | 68% |
| Wc Meijers | $149 | 68% |
| Wc Michigan | $149 | 68% |
| Wc Mitchell Frankenmuth | $149 | 68% |
| Wc Pma | $149 | 68% |
| Wc Sedgwick | $149 | 68% |
| Wc Sentry | $149 | 68% |
| Wc Travelers | $149 | 68% |
| Wc Tristar | $149 | 68% |
| Wc Walmart | $149 | 68% |
| Wc Zurich | $149 | 68% |
| Hospice Of Michigan | $153 | 69% |
| Nomi Health | $156 | 71% |
| Varipro | $161 | 73% |
| Cigna | $175 | 79% |
| Caresource | $176 | 80% |
| U Of M Health Plan | $184 - $220 | 83% |
| Geha | $189 - $246 | 86% |
| Meritain | $189 | 86% |
| 1199 National Benefit Fund | $209 | 95% |
| Allied National Global Care | $209 | 95% |
| Asrm - Reliance Standard Life Insurance | $209 | 95% |
| Christian Care Ministry | $209 | 95% |
| Dean Health | $209 | 95% |
| Fallon Health | $209 | 95% |
| Family Life Insurance Company | $209 | 95% |
| Ghc Scw | $209 | 95% |
| Group Pension Administrators | $209 | 95% |
| International Benefit Administrators | $209 | 95% |
| Lifetime Benefit Solutions | $209 | 95% |
| Manhattan Life | $209 | 95% |
| Medi Share | $209 | 95% |
| Multiplan | $209 | 95% |
| Mvp | $209 | 95% |
| Pai | $209 | 95% |
| Pan-American Life | $209 | 95% |
| Paramount Hmo | $209 | 95% |
| Phcs | $209 | 95% |
| Trinity Health Share | $209 | 95% |
| Acclaim | $220 | 100% |
| Administrative Concepts | $220 | 100% |
| Allegeant | $220 | 100% |
| Ameriben | $220 | 100% |
| American Family | $220 | 100% |
| American Healthcare Alliance | $220 | 100% |
| American Republic | $220 | 100% |
| Amerihealth | $220 | 100% |
| Aultcare | $220 | 100% |
| Automated Benefit Services | $220 | 100% |
| Auxiant | $220 | 100% |
| Benefit Administrative Systems,Llc | $220 | 100% |
| Boon Chapman | $220 | 100% |
| Cam Administrative Services | $220 | 100% |
| Christian Brother Services | $220 | 100% |
| Christian Brothers Holy Cross | $220 | 100% |
| Comprehensive Benefits | $220 | 100% |
| Continental Life Insurance | $220 | 100% |
| Custom Benefit Administrators | $220 | 100% |
| Employee Benefit Concepts | $220 | 100% |
| Employee Benefit Management | $220 | 100% |
| Enterprise Group Planning | $220 | 100% |
| Freedom Life Insurance Company | $220 | 100% |
| Group Administrators | $220 | 100% |
| Group Marketing Services | $220 | 100% |
| Guardian | $220 | 100% |
| Health America | $220 | 100% |
| Healthez | $220 | 100% |
| Humana | $220 | 100% |
| Insight | $220 | 100% |
| Intercare | $220 | 100% |
| Jfp Benefit Management | $220 | 100% |
| Jp Farley Corporation | $220 | 100% |
| Key Benefit Administrator | $220 | 100% |
| Liberty Union Life Assurance Co | $220 | 100% |
| Lucent Health | $220 | 100% |
| Luminare Health | $220 | 100% |
| Luminare Health (Detroit) | $220 | 100% |
| Medben | $220 | 100% |
| Medcost | $220 | 100% |
| Medical Mutual | $220 | 100% |
| Mutual Health Services | $220 | 100% |
| Mutual Of Omaha | $220 | 100% |
| Ncas | $220 | 100% |
| Nippon Life Ins | $220 | 100% |
| Nova | $220 | 100% |
| Painters Union Insurance Fund | $220 | 100% |
| Physicians Mutual | $220 | 100% |
| Plumbers Local 98 Insurance Fund | $220 | 100% |
| Prairie States | $220 | 100% |
| Primary Physician Care | $220 | 100% |
| Professional Benefit Administrators | $220 | 100% |
| The Loomis Company | $220 | 100% |
| Unicare | $220 | 100% |
| Us Health And Life | $220 | 100% |
| Valenz | $220 | 100% |
| Western & Southern Financial Group | $220 | 100% |
| Wps | $220 | 100% |
| First Health | $229 | 104% |
| UnitedHealthcare | $246 | 112% |
| Barinet | $279 | 126% |
| Cmh Allegan County | $279 | 126% |
| Cmh Barry County | $279 | 126% |
| Cmh Berrien County | $279 | 126% |
| Cmh Cass County | $279 | 126% |
| Cmh Kalamazoo | $279 | 126% |
| Cmh Kent County | $279 | 126% |
| Cmh Misc | $279 | 126% |
| Cmh Muskegon County | $279 | 126% |
| Cmh North Country | $279 | 126% |
| Cmh Northern Lakes County | $279 | 126% |
| Cmh Ottawa County | $279 | 126% |
| Cmh Van Buren County | $279 | 126% |
| Cmh West Mi County | $279 | 126% |
| Priority Health | $300 - $335 | 136% |