CMS Price Transparency Data

Neurobehavioral status check

Facility: Sparrow Ionia Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $146
Cash Discount Price: $91
vs. Medicare Baseline: 0.66x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Sparrow Ionia Hospital is $146. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $91. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.66x the Medicare baseline. Located in 3565 S State Road, Ionia, MI.

Cash / Self-Pay

$91

Average discount available for prompt cash payment at this facility.

Insurance Median

$146

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: $91 (41%)

Insurance Median: $146 (66%)

Cash: $91 (41% of Medicare)

Ins. Median: $146 (66% 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

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$46 - $428	21%
Covenant Advantage	$46 - $143	21%
Medicare (plans)	$46 - $151	21%
Medigold	$46 - $143	21%
Senior Community Care	$46 - $143	21%
Humana	$48 - $463	22%
Medicaid / KanCare	$50 - $243	23%
Priority	$112 - $350	51%
Blue Cross Blue Shield	$114 - $358	52%
UnitedHealthcare	$140 - $438	63%
Cigna	$144 - $452	65%
Great West Healthcare	$144 - $452	65%
Asr	$146 - $457	66%
Blue Care Network	$146 - $457	66%
Health Alliance Plan	$146 - $457	66%
Cofinity	$147 - $463	67%
Mclaren Commercial	$162 - $509	73%
Priority Health Medihmo	$221	100%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $91.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 96116.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sparrow Ionia Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 96116.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.