CMS Price Transparency Data

Neurobehavioral status check

Facility: Gundersen Lutheran Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $305
Cash Discount Price: $150
vs. Medicare Baseline: 1.38x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Gundersen Lutheran Medical Center is $305. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.38x the Medicare baseline. Located in 1910 South Ave, La Crosse, WI.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$305

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: $150 (68%)

Insurance Median: $305 (138%)

Cash: $150 (68% of Medicare)

Ins. Median: $305 (138% 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
Blue Cross Blue Shield	$127 - $612	58%
Medica	$133 - $304	60%
Ucare	$159 - $324	72%
Dean Health Plan	$166	75%
Quartz	$168	76%
Aetna	$175 - $377	79%
Health Partners	$198 - $351	90%
Amerigroup	$264 - $308	120%
Group Health Eau Claire	$264 - $357	120%
Group Health Of South Central	$264 - $318	120%
Icare	$264 - $308	120%
Iowa Total Care	$264	120%
Managed Health Service	$264	120%
Molina Health	$264 - $301	120%
UnitedHealthcare	$264 - $324	120%
Medical Associates	$278 - $308	126%
Midland Choice	$298	135%
Alliance	$312 - $334	141%
Claim Doc Llc	$318	144%
Wps Narrow Network	$322	146%
Cigna	$326	148%
Wps - Arise	$326	148%
Aspirus Arise Health	$330	150%
Allied National General	$337	153%
Preferred One	$337	153%
Wps Statewide	$337	153%
Coventry Health Care	$377	171%
Humana	$377	171%
Multiplan/Healtheos	$381	173%

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 $150.
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 Gundersen Lutheran 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.