CMS Price Transparency Data

Neurobehavioral status check

Facility: Ascension St Vincent's Riverside

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $316
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.43x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Ascension St Vincent's Riverside is $316. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.43x the Medicare baseline. Located in 1 Shircliff Way, Jacksonville, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$316

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%)

Insurance Median: $316 (143%)

Ins. Median: $316 (143% 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
Humana	$220 - $316	100%
Bc Advantage Mcr Replacement	$313	142%
Blue Cross Blue Shield	$313	142%
Community Hospice	$313	142%
Coventry Mcr Replacement Hmo	$313	142%
Haven Hospice	$313	142%
Heartland Of Hc	$313	142%
Medicare (plans)	$313 - $319	142%
Pace Place	$313	142%
Research Study Encore Borland-Groover	$313	142%
Veterans Administration	$313	142%
Wellcare	$313	142%
Cigna	$316 - $319	143%
UnitedHealthcare	$316	143%
Careplus Mcr Replacement	$319	145%
Aetna	$322 - $641	146%
Bright Health	$422 - $453	191%
Smarthealth	$438	199%
Oscar Health Plan	$500	227%
Employer Direct Healthcare	$547	248%
90 Degree Benefits	$563	255%
Avmed Exchange	$563	255%
Molina Exchange	$578	262%
Occunet	$578 - $703	262%
Ambetter / Centene	$594	269%

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 $X.
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 Ascension St Vincent's Riverside 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.