CMS Price Transparency Data

Neurobehavioral status check

Facility: Cascade Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $323
Cash Discount Price: $426
vs. Medicare Baseline: 1.46x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Cascade Medical Center is $323. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $426. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.46x the Medicare baseline. Located in 817 Commercial Street, Leavenworth, WA.

Cash / Self-Pay

$426

Average discount available for prompt cash payment at this facility.

Insurance Median

$323

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: $426 (193%)

Insurance Median: $323 (146%)

Cash: $426 (193% of Medicare)

Ins. Median: $323 (146% 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
Tricare	$93	42%
First Choice Health Network	$128	58%
Pacificsource Health Plans	$128	58%
Medicaid / KanCare	$284 - $299	129%
Community Health Plan Of Wa Mcd Rep	$296 - $311	134%
Coordinated Care Of Wa Mcd Rep	$296 - $311	134%
Molina Healthcare Of Washington Mcd Rep	$296 - $311	134%
Asuris Northwest Health	$297 - $503	135%
Aetna	$308 - $503	140%
Blue Cross Blue Shield	$308 - $425	140%
Humana	$308 - $323	140%
Medicare (plans)	$308 - $323	140%
Molina Healthcare Of Washington Mcr Adv	$311 - $326	141%
Wellcare Health Plan Inc Mcr Adv	$332 - $349	150%
Ambetter / Centene	$334 - $350	151%
Community Health Plan Of Wa	$346 - $363	157%
Cigna	$445 - $467	202%
Washington Department Of Labor And Industry	$475 - $499	215%

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 $426.
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 Cascade Medical Center 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.