CMS Price Transparency Data

Neurobehavioral status check

Facility: Winter Haven Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $150
Cash Discount Price: $112
vs. Medicare Baseline: 0.68x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Winter Haven Hospital is $150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $112. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.68x the Medicare baseline. Located in 200 Ave F Ne, Winter Haven, FL.

Cash / Self-Pay

$112

Average discount available for prompt cash payment at this facility.

Insurance Median

$150

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: $112 (51%)

Insurance Median: $150 (68%)

Cash: $112 (51% of Medicare)

Ins. Median: $150 (68% 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
Molina	$34 - $111	15%
Simply Healthcare	$34 - $84	15%
Ultimate Health Plan	$56	25%
Avmed	$58 - $92	26%
Blue Cross Blue Shield	$60 - $313	27%
Clear Health Alliance	$80	36%
UnitedHealthcare	$81 - $334	37%
Humana	$83 - $391	38%
Freedom Health	$84	38%
Molina Healthcare	$84	38%
Sunshine Health	$84	38%
Aetna	$85 - $359	39%
Florida Hospital	$86	39%
Florida Community Care	$88	40%
Evolutions	$94 - $174	43%
Cigna	$99 - $359	45%
Multiplan	$150	68%
First Health	$159	72%
Ambetter / Centene	$187 - $797	85%
United Behavioral Health	$187	85%
Baycareplus	$313	142%
Careplus	$322	146%
Solis Health	$344	156%
Freedom	$347	157%
Optimum	$347	157%
Health First	$359	163%
Wellcare	$438	199%

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 $112.
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 Winter Haven 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.