CMS Price Transparency Data

Neurobehavioral status check

Facility: Sanford Usd Medical Center

Billing Code: 96116 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$260

about 1.2× the $221 Medicare rate · typically $192–$311

modeled estimate · not a bill or quote

What this hospital charges insurers

$321

Above the fair price

about $61 over the fair price · 1.5× Medicare

Medicare pays $221 Fair price $260 This hospital $321 Cash price $414 Hospital's list price $518

How we calculate the fair BaseRate →

How this hospital compares to other SD hospitals

One of the lower prices — 2 of 4 other SD hospitals charge more for the same procedure.

Cheapest $86 Priciest $974

Black dot = this hospital, among the 5 SD hospitals with a price for this procedure. Full list below.

A fair price for a Neurobehavioral status check is about $260 (about 1.2× the $221 Medicare rate). Sanford Usd Medical Center charges insurers about $321, or about $414 in cash — above the fair price. Located in Sioux Falls, SD.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $260. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna CignaHumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$321 - $456	146%
Blue Cross Blue Shieldmajor	$139 - $395	63%
Aetnamajor	$321 - $396	146%
Health Net	$466	211%
HealthPartners	$174 - $321	79%
Medica	$349 - $373	158%
Sanford Health Plan	$79 - $296	36%
Security Health Plan	$285	129%
UCare	$318 - $364	144%
+ 2 smaller / regional plans	$327 - $466

Government programs also on file: Medicare.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 414), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 96116.

Insurance Before you use insurance

Call your insurance company to confirm Sanford Usd Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 96116.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Sanford Usd Medical Center

Compare: Neurobehavioral status check at other SD hospitals

Insurance negotiated median for the same procedure, sorted lowest first.