CMS Price Transparency Data

Neurobehavioral status check

Facility: Grossmont Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $923
Cash Discount Price: $1,097
vs. Medicare Baseline: 4.18x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Grossmont Hospital is $923. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,097. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 4.18x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$1,097

Average discount available for prompt cash payment at this facility.

Insurance Median

$923

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: $1,097 (497%)

Insurance Median: $923 (418%)

Cash: $1,097 (497% of Medicare)

Ins. Median: $923 (418% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 418% of the Medicare baseline (a markup of 318%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$219 - $1,170	99%
Blue Cross Blue Shield	$219 - $1,023	99%
Health Net	$409 - $1,170	185%
Managed Health Network	$497 - $814	225%
Medicare (plans)	$497 - $933	225%
Interplan	$700	317%
Medi-Cal	$804	364%
Blue Shield	$826 - $980	374%
Community Health Group	$877 - $1,316	398%
Molina	$914 - $1,023	414%
Indian Health Council	$933	423%
Kaiser	$933	423%
UnitedHealthcare	$1,009 - $1,170	457%
California Health And Wellness	$1,023	464%
Cigna	$1,023 - $1,096	464%
Humana	$1,023	464%
San Diego Pace	$1,096	497%
County Medical Services	$1,170 - $1,316	530%

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 $1,097.
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 Grossmont 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.