CMS Price Transparency Data

Neurobehavioral status check

Facility: Geisinger-Lewistown Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $398
Cash Discount Price: $508
vs. Medicare Baseline: 1.80x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Geisinger-Lewistown Hospital is $398. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $508. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.80x the Medicare baseline. Located in 400 Highland Avenue, Lewistown, PA.

Cash / Self-Pay

$508

Average discount available for prompt cash payment at this facility.

Insurance Median

$398

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: $508 (230%)

Insurance Median: $398 (180%)

Cash: $508 (230% of Medicare)

Ins. Median: $398 (180% 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	$69	31%
Geisinger Family Plan	$74	34%
Amerihealth	$76	34%
Upmc Health Plan	$81 - $11,890	37%
Health Partners	$82	37%
Upmc Chip	$86	39%
Blue Cross Blue Shield	$269 - $911	122%
Geisinger Health Plan	$302 - $1,416	137%
Medicare (plans)	$302	137%
Advantra	$305	138%
Humana	$305	138%
Aetna	$335 - $398	152%
Cigna	$354 - $431	160%
UnitedHealthcare	$363	165%
Christian Healthcare Ministries	$410	186%
Christian Health Aid	$655	297%
Three Rivers Provider Network Inc.	$655	297%
Multiplan	$696	316%
Ambetter / Centene	$725	329%
Healthsmart Payors Organization	$737	334%

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 $508.
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 Geisinger-Lewistown 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.