CMS Price Transparency Data

Neurobehavioral status check

Facility: Lakewood Health System

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $96
Cash Discount Price: $144
vs. Medicare Baseline: 0.44x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Lakewood Health System is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $144. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.44x the Medicare baseline. Located in 49725 County Road 83, Staples, MN.

Cash / Self-Pay

$144

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

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: $144 (65%)

Insurance Median: $96 (44%)

Cash: $144 (65% of Medicare)

Ins. Median: $96 (44% 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
Blue Cross Blue Shield	$90 - $171	41%
UnitedHealthcare	$93 - $206	42%
Humana	$94	43%
Ucare Mcr Adv	$96	44%
Ucare Msho/Special Needs	$96	44%
Ucare Individual/Family - All Other Plans	$107	49%
Medica Choice Care	$113	51%
Health Partners - All Plans	$218	99%
Preferred One Hmo	$220	100%
Preferred One Ppo - All Other Plans	$220	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 $144.
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 Lakewood Health System 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.