CMS Price Transparency Data

Neurobehavioral status check

Facility: Adventist Health Tulare

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $84
Cash Discount Price: $37
vs. Medicare Baseline: 0.38x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Adventist Health Tulare is $84. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.38x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$37

Average discount available for prompt cash payment at this facility.

Insurance Median

$84

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: $37 (17%)

Insurance Median: $84 (38%)

Cash: $37 (17% of Medicare)

Ins. Median: $84 (38% 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 Mcare	$73	33%
Fhcn Pace Mcr Adv - All Plans	$73	33%
Medicare (plans)	$73	33%
Tricare	$73	33%
UnitedHealthcare	$73 - $109	33%
Upn-United Physcn Ntwrk Mcr Adv Profee Only-All Ot	$73	33%
Ah Employee Health Plan - All Plans	$80	36%
Incentive Hlth - All Plans	$80	36%
Blue Cross Blue Shield	$84 - $167	38%
Ccipa Medi-Cal - All Plans	$84	38%
Healthnet Medi-Cal	$84	38%
Medi-Cal	$84	38%
Upn-United Physcn Ntwrk Mcal Profee Only	$84	38%
Aetna	$89	40%
Hs Interplan-All Plans	$91	41%
Cal Forensic Med Grp - All Plans	$95	43%
Cigna	$103	47%
Healthnet Hmo/Ppo - All Other Plans	$106	48%
Blue Shield Epn	$152	69%
Blue Shield-All Other Plans	$161	73%

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 $37.
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 Adventist Health Tulare 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.