CMS Price Transparency Data

Neurobehavioral status check

Facility: Pine Rest Christian Mental Health Services

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $90
Cash Discount Price: $150
vs. Medicare Baseline: 0.41x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Pine Rest Christian Mental Health Services is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.41x the Medicare baseline. Located in 300 - 68Th Street, Se, Grand Rapids, MI.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $150 (68%)

Insurance Median: $90 (41%)

Cash: $150 (68% of Medicare)

Ins. Median: $90 (41% 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
Medicaid / KanCare	$38 - $59	17%
UnitedHealthcare	$38 - $97	17%
Aetna	$50 - $172	23%
Blue Cross Blue Shield	$50 - $152	23%
Beacon/Carelon Behavioral Health [1198]	$75	34%
Champva [1117]	$79 - $90	36%
Humana	$79 - $114	36%
Medicare (plans)	$79 - $90	36%
Molina [1156]	$79 - $90	36%
Tricare	$79 - $90	36%
Veterans Administration [1174]	$79 - $90	36%
Cigna	$91	41%
Golden Rule [1131]	$97	44%
Healthscope Benefits [1140]	$97	44%
Ubh [1167]	$97	44%
Blue Care Network [1000]	$113	51%
University Of Michigan Health Plan Comm [1159]	$118	53%
University Of Michigan Health Plan [1205]	$118	53%
Behavioral Health Systems [1115]	$121	55%
Mclaren Health Plan [1149]	$122	55%
Priority Health [1300]	$131 - $152	59%
Asr Physicians Care Health Plan [1160]	$138	63%
Hap Ppo/Health Alliance Plan [1134]	$138	63%
Cofinity [1120]	$172	78%
Geha [1129]	$172	78%
Meritain Health Plan [1153]	$172	78%

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 $150.
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 Pine Rest Christian Mental Health Services 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.