CMS Price Transparency Data

Neurobehavioral status check

Facility: Loma Linda University Children's Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $457
Cash Discount Price: $460
vs. Medicare Baseline: 2.07x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Loma Linda University Children's Hospital is $457. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $460. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 2.07x the Medicare baseline. Located in 11234 Anderson Street Suite A, Loma Linda, CA.

Cash / Self-Pay

$460

Average discount available for prompt cash payment at this facility.

Insurance Median

$457

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: $460 (209%)

Insurance Median: $457 (207%)

Cash: $460 (209% of Medicare)

Ins. Median: $457 (207% 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 207% of the Medicare baseline (a markup of 107%). 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
Inland Empire Health Plan (Iehp)	$94 - $396	43%
Kaiser Foundation Hospitals	$107 - $682	49%
Adventist Health	$205 - $419	93%
UnitedHealthcare	$206 - $417	93%
Lluh Dept Of Risk Management	$246	112%
Blue Shield Of California	$279 - $421	126%
Alpha Care Medical Group	$396 - $593	180%
Dignity Health	$396 - $593	180%
Epic Health Plan	$396 - $534	180%
Upland Medical Group	$396	180%
Vantage Medical Group	$396 - $593	180%
Blue Cross Blue Shield	$457	207%
Trivalley Medical Group	$475	215%
Molina Healthcare Of Ca	$499 - $530	226%
Global Benefits Group	$614	278%
Temecula Valley Physicians Medical Group	$614	278%
Heritage Provider Network	$649	294%
Cigna	$655 - $757	297%
Networks By Design	$665	301%
Aetna	$671	304%
Multiplan	$818	371%
Galaxy Health	$870	394%
Prime Health Services	$870	394%

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 $460.
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 Loma Linda University Children'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.