CMS Price Transparency Data

Neurobehavioral status check

Facility: Adventist Health Mendocino Coast

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $175
Cash Discount Price: $150
vs. Medicare Baseline: 0.79x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Adventist Health Mendocino Coast is $175. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.79x the Medicare baseline. Located in 700 River Drive, Fort Bragg, CA.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$175

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: $150 (68%)

Insurance Median: $175 (79%)

Cash: $150 (68% of Medicare)

Ins. Median: $175 (79% 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
Cigna	$73 - $253	33%
Tricare	$73 - $159	33%
UnitedHealthcare	$73 - $262	33%
Ah Employee Health Plan - All Plans	$80 - $168	36%
Medi-Cal	$84	38%
Blue Shield Epn	$86 - $152	39%
Blue Cross Blue Shield	$92 - $275	42%
Healthnet - All Plans	$106 - $211	48%
Partnership Hp Mcal-All Plans	$121 - $251	55%
Great West Hmo/Pos/Epo/Oa	$148 - $211	67%
Great West Ppo - All Other Plans	$159 - $227	72%
Multiplan - All Plans	$159 - $227	72%
Blue Shield - All Other Plans	$161 - $249	73%
Ahcc - All Plans	$194 - $292	88%
Beech Street - All Plans	$194 - $292	88%

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 $150.
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 Mendocino Coast 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.