CMS Price Transparency Data

Neurobehavioral status check

Facility: Memorialcare Orange Coast Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $330
Cash Discount Price: $916
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Memorialcare Orange Coast Medical Center is $330. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $916. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.50x the Medicare baseline. Located in 9920 Talbert Avenue, Fountain Valley, CA.

Cash / Self-Pay

$916

Average discount available for prompt cash payment at this facility.

Insurance Median

$330

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: $916 (415%)

Insurance Median: $330 (150%)

Cash: $916 (415% of Medicare)

Ins. Median: $330 (150% 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 Shield	$161 - $272	73%
Seoul Medical Group	$250	113%
Blue Cross Blue Shield	$278 - $758	126%
Molina	$286	130%
Universal Care	$292	132%
Central Health	$305	138%
Clever Care	$333	151%
Healthcare Partners	$347 - $755	157%
Select Health	$375	170%
Monarch Health Plan	$447 - $694	203%
Centivo	$625	283%

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 $916.
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 Memorialcare Orange Coast 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.