CMS Price Transparency Data

Neurobehavioral status check

Facility: Medstar Washington Hospital Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $1,005
Cash Discount Price: $1,094
vs. Medicare Baseline: 4.56x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Medstar Washington Hospital Center is $1,005. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,094. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 4.56x the Medicare baseline. Located in 110 Irving Street Nw, Washington, DC.

Cash / Self-Pay

$1,094

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,005

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: $1,094 (496%)

Insurance Median: $1,005 (456%)

Cash: $1,094 (496% of Medicare)

Ins. Median: $1,005 (456% 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 456% of the Medicare baseline (a markup of 356%). 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
Carefirst Advantage Inc	$255	116%
Tricare	$255	116%
UnitedHealthcare	$255 - $488	116%
Aetna	$263 - $1,078	119%
Health Care Service Corporation	$268	121%
Humana	$268	121%
Kaiser Permanente	$268 - $1,163	121%
Carefirst Blue Choice Inc	$441	200%
Medstar Family Choice Inc	$808 - $1,327	366%
Cigna	$1,005	456%
Pfc	$1,094	496%
Ncppo Healthlink Ppo	$1,263	573%
Amerigroup	$1,327	602%
Amerihealth Caritas District Of Columbia	$1,327	602%
Hscsn	$1,327	602%
Private Healthcare Systems (Phcs)	$1,347	611%
First Health	$1,431	649%

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 $1,094.
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 Medstar Washington Hospital Center 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.