Neurobehavioral status check
Facility: Golden Valley Memorial Hospital
Billing Code: 96116 (CPT)
- CPT Billing Code: 96116
- Insurance Median: $313
- Cash Discount Price: $263
- vs. Medicare Baseline: 1.42x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Home State Health | $281 | 127% |
| UnitedHealthcare | $281 - $532 | 127% |
| Aetna | $313 | 142% |
| Humana | $313 | 142% |
| Ambetter / Centene | $375 | 170% |
Consumer Guidance & Cost Commentary
For a Neurobehavioral status check at Golden Valley Memorial Hospital in Clinton, MO, the cash median price is $263. This facility, operated by the Government - Hospital District or Authority, lists a gross charge of $438 and a negotiated rate of $313. When compared to the state of Missouri, the cash price is lower than the state average, while the negotiated rate is higher. Patients should note that while insurance often negotiates a ceiling rate of $313, paying cash directly can result in a lower out-of-pocket cost of $263, which may be preferable for those with high-deductible plans.
The Medicare benchmark for this service is $220.60, meaning the negotiated rate is 1.4 times the Medicare amount. Since the facility is an Acute Care Hospital with a rating of 3, it is important for patients to verify their specific plan details with UnitedHealthcare (range $281-$532), Home State Health ($281), Aetna ($313), Humana ($313), or Ambetter / Centene ($375) before scheduling. To potentially reduce costs further, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can offer a fee reduction of up to 50% for upfront payment, bypassing the administrative overhead associated with insurance claims processing.