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CMS Price Transparency Data Hospital file updated: 1/1/2025

Neurobehavioral status check

Facility: Southwestern Vermont Medical Center

Billing Code: 96116 (CPT)

Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Near Fair BaseRate Benchmark
$110Fair BaseRate (0.99× Market)
Position vs. 1.00× Fair PriceRight at U.S. Average (0%) 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

This hospital's typical commercial price is $109 compared to the $110 fair price benchmark.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Quality Benchmark
CMS Star Rating3/5 StarsOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety Score60/100Composite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

3-Star CMS clinical quality rating paired with 0.99× fair market pricing.

The BaseRate · fair price high confidence
A fair price for this
$110
about 0.5× the $221 Medicare rate · typically $80–$196
modeled estimate · not a bill or quote
What this hospital charges insurers
$109
About the fair price
about $1 under the fair price · 0.5× Medicare
Medicare pays $221 Fair price $110 This hospital $109 Cash price $263 Hospital's list price $375

How we calculate the fair BaseRate →

How this hospital compares to other VT hospitals

A typical price — 2 charge more and 2 charge less, among the 5 VT hospitals compared.

Cheapest $87 Priciest $189

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

A fair price for a Neurobehavioral status check is about $110 (about 0.5× the $221 Medicare rate). Southwestern Vermont Medical Center charges insurers about $109, or about $263 in cash — about the fair price. Located in Bennington, VT.

What each insurance company pays

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

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

UnitedHealthcareBlue Cross Blue ShieldAetnaCignaHumana Kaiser 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 $70 - $318 32%
Blue Cross Blue Shieldmajor $86 - $318 39%
Aetnamajor $86 - $318 39%
Cignamajor $86 - $318 39%
Humanamajor $86 - $318 39%
CDPHP $51 - $318 23%
Fidelis Care $86 - $334 39%
Harvard Pilgrim $127 58%
MVP Health Care $59 - $318 27%
Tufts Health Plan $129 58%
WellCare $86 - $318 39%
+ 3 smaller / regional plans $75 - $318

Self-Pay How to get the cash price

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Facility Profile & Credentials

  • Address: 100 Hospital Drive, Bennington, VT 05201
  • CMS Rating: 3 / 5 Stars
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals

Other Procedures at Southwestern Vermont Medical Center

Compare: Neurobehavioral status check at other VT hospitals

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

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at Southwestern Vermont Medical Center (Zero PHI Required)

CMS CCN: 470012
CPT 96116
Fair BaseRate™ $110
Medicare Rate $221
Self-Pay Cash $263
Insurer Median $109
Pre-filled with Southwestern Vermont Medical Center’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $136 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $136

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $136).

Step 2 · Cash vs. Insurance Arbitrage Save $112 Paying Cash

Self-Pay Cash Rate ($263) Beats Your Bill

Southwestern Vermont Medical Center's published 45 CFR § 180 self-pay cash rate is $263 (vs. $109 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$265 Above Fair BaseRate

Negotiate Toward $110 Fair BaseRate ($221 Medicare)

Your bill ($375) is $265 above the denoised Fair BaseRate ($110) and 1.7× the $221 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Overall3/5 Stars (3/5)

Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

45 CFR § 180 Primary-Source Lineage & Federal Verification Verified CMS CCN 470012

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

Download Official Hospital MRF ↗ Verify on CMS Medicare.gov (CCN 470012) ↗ CMS HCRIS Cost Reports ↗
Published MRF FileCMS_45_CFR_180_FILING.json
Publication / Vintage1/1/2025
Validated Rate RowsIndexed (CMS v2.0.0)
File Integrity DigestVerified · CCN 470012

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy