CMS Price Transparency Data

Neurobehavioral status check

Facility: Essentia Health St Mary's Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 96116
  • Insurance Median: $312
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.41x Medicare
The contracted insurance negotiated median rate for a Neurobehavioral status check at Essentia Health St Mary's Medical Center is $312. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.41x the Medicare baseline. Located in 402 East Second Street, Duluth, MN.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$312

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%)
Insurance Median: $312 (141%)
Ins. Median: $312 (141% 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.

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
Primewest $303 137%
Itasca Med Care $311 141%
Advocare/Security Health $312 141%
Blue Cross Blue Shield $312 - $724 141%
Freedom Blue Ppo $312 141%
Healthpartners Care Msho / Mcr Adv $312 141%
Imcare Msho (Ref Req) $312 141%
Imcare Msho Pcc Prime $312 141%
Imcare Msho Ref Req $312 141%
Medica Advantage Solutions $312 141%
Medica Msho/Dual Solutions $312 141%
Medica Prime Solution Group $312 141%
Medicare (plans) $312 141%
Nd Va Administration $312 141%
Platinum Blue / Vantage Blue $312 141%
Primewest Msho $312 141%
Secure Blue Msho $312 141%
Ubh Cost Plan $312 141%
Ubh Msho $312 141%
Ucare Msho $312 141%
UnitedHealthcare $312 141%
Sanford Health Plan $551 250%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 402 East Second Street, Duluth, MN 55805
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals