CMS Price Transparency Data

Neurobehavioral status check

Facility: Gaylord Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $698
Cash Discount Price: $611
vs. Medicare Baseline: 3.16x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Gaylord Hospital is $698. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $611. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 3.16x the Medicare baseline. Located in 50 Gaylord Farm Rd, Wallingford, CT.

Cash / Self-Pay

$611

Average discount available for prompt cash payment at this facility.

Insurance Median

$698

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: $611 (277%)

Insurance Median: $698 (316%)

Cash: $611 (277% of Medicare)

Ins. Median: $698 (316% 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 316% of the Medicare baseline (a markup of 216%). 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
Aetna	$74 - $3,198	34%
Blue Cross Blue Shield	$74 - $3,856	34%
Connecticare	$74 - $3,940	34%
UnitedHealthcare	$74 - $3,819	34%
Cigna	$132 - $3,722	60%
Harvard Pilgrim	$264 - $3,940	120%
Yale Health Plan	$283 - $4,218	128%
Multiplan	$698 - $3,708	316%

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 $611.
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 Gaylord 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.