CMS Price Transparency Data

Neurobehavioral status check

Facility: USA Health Children's & Women's Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $94
Cash Discount Price: $174
vs. Medicare Baseline: 0.43x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at USA Health Children's & Women's Hospital is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $174. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.43x the Medicare baseline. Located in 1700 Center Street, Mobile, AL.

Cash / Self-Pay

$174

Average discount available for prompt cash payment at this facility.

Insurance Median

$94

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: $174 (79%)

Insurance Median: $94 (43%)

Cash: $174 (79% of Medicare)

Ins. Median: $94 (43% 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
Central Healthcare Services	$87	39%
Blue Cross Blue Shield	$92	42%
Aetna	$94	43%
Devoted Health	$94	43%
Humana	$94	43%
UnitedHealthcare	$94	43%
Viva Health	$94	43%
Wellcare	$94	43%
Molina Marketplace	$104	47%
Ambetter / Centene	$113	51%
Mississippi Physicians Care Network (Mpcn)	$127	58%

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 $174.
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 USA Health Children's & Women's Hospital 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.