CMS Price Transparency Data

Neurobehavioral status check

Facility: Glens Falls Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $100
Cash Discount Price: $221
vs. Medicare Baseline: 0.45x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Glens Falls Hospital is $100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $221. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.45x the Medicare baseline. Located in 100 Park Street, Glens Falls, NY.

Cash / Self-Pay

$221

Average discount available for prompt cash payment at this facility.

Insurance Median

$100

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: $221 (100%)

Insurance Median: $100 (45%)

Cash: $221 (100% of Medicare)

Ins. Median: $100 (45% 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	$46 - $82	21%
Cdphp	$51 - $447	23%
Medicare (plans)	$56 - $87	25%
UnitedHealthcare	$56 - $375	25%
Emblem Health Ghi	$64 - $87	29%
Tricare	$64 - $87	29%
Blue Cross Blue Shield	$69 - $376	31%
Aetna	$75 - $372	34%
Fidelis	$75 - $447	34%
Mvp	$76 - $417	34%
Blue Shield Highmark	$98 - $118	44%
Blue Shield	$111 - $263	50%
Cigna	$119 - $165	54%
Hamaspik	$287	130%
Nascentia Health Options	$287	130%
Magnacare	$331 - $368	150%
Emblem	$353	160%
Empire Plan Nyship	$375 - $376	170%
Multiplan	$375	170%
Mvp Commercial	$391 - $441	177%

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 $221.
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 Glens Falls 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.