CMS Price Transparency Data

Neurobehavioral status check

Facility: Adventist Health Howard Memorial

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $131
Cash Discount Price: $63
vs. Medicare Baseline: 0.59x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Adventist Health Howard Memorial is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.59x the Medicare baseline. Located in 1 Marcela Dr, Willits, CA.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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: $63 (29%)

Insurance Median: $131 (59%)

Cash: $63 (29% of Medicare)

Ins. Median: $131 (59% 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	$39 - $73	18%
Medicare (plans)	$39 - $73	18%
Tricare	$39 - $73	18%
UnitedHealthcare	$43 - $176	19%
Medi-Cal	$56 - $84	25%
Ah Employee Health Plan - All Plans	$80 - $118	36%
Cigna	$98 - $193	44%
Aetna	$99 - $152	45%
Western Growers/Pinnacle - All Plans	$104 - $170	47%
Healthnet - All Plans	$106 - $186	48%
Blue Cross Blue Shield	$126 - $193	57%
Blue Shield - All Other Plans	$133 - $161	60%
Blue Shield Epn	$133 - $155	60%
First Health Ppo - All Plans	$155 - $182	70%
Ghn Ppo - All Plans	$155 - $182	70%
Brms - All Plans	$165 - $193	75%

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 $63.
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 Howard Memorial 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.