CMS Price Transparency Data

Neurobehavioral status check

Facility: Lee County Community Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 96116
  • Insurance Median: $135
  • Cash Discount Price: $126
  • vs. Medicare Baseline: 0.61x Medicare
The contracted insurance negotiated median rate for a Neurobehavioral status check at Lee County Community Hospital is $135. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $126. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.61x the Medicare baseline. Located in 127 Health Care Drive, Pennington Gap, VA.
Cash / Self-Pay
$126

Average discount available for prompt cash payment at this facility.

Insurance Median
$135

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: $126 (57%)
Insurance Median: $135 (61%)
Cash: $126 (57% of Medicare)
Ins. Median: $135 (61% 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.

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
UnitedHealthcare $83 - $1,150 38%
Blue Cross Blue Shield $102 - $1,116 46%
Aetna $121 - $1,161 55%
Ambetter / Centene $121 55%
Amerigroup $121 - $548 55%
Managed Medicaire $121 55%
Medicare (plans) $121 55%
Mountain Empire Pace $121 55%
Sentara Health $121 - $141 55%
United Mine Workers Of America $121 55%
Humana $122 55%
Molina Healthcare $125 - $1,161 57%
Cigna $127 - $548 58%
Devoted Health Plan $127 58%
Nhc Advantage $127 58%
Seven Corners, Inc. $289 131%
First Health Coventry $548 248%
Medcost $548 248%
Optima Health $1,116 506%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 127 Health Care Drive, Pennington Gap, VA 24277
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals