CMS Price Transparency Data

Neurobehavioral status check

Facility: Northside Hospital Duluth

Billing Code: 96116 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$313

about 1.4× the $221 Medicare rate · typically $141–$481

modeled estimate · not a bill or quote

What this hospital charges insurers

$219

Below the fair price — a good deal

about $94 under the fair price · 1.0× Medicare

Medicare pays $221 Fair price $313 This hospital $219 Cash price $887 Hospital's list price $1,182

How we calculate the fair BaseRate →

How this hospital compares to other GA hospitals

Highest price of the 9 GA hospitals we have prices for — worth calling around.

Cheapest $88 Priciest $219

Black dot = this hospital, among the 9 GA hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Neurobehavioral status check is about $313 (about 1.4× the $221 Medicare rate). Northside Hospital Duluth charges insurers about $219, or about $887 in cash — below the fair price — a good deal. Located in Duluth, GA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$141 - $213	64%
Blue Cross Blue Shieldmajor	$213 - $824	97%
Aetnamajor	$215 - $804	97%
Cignamajor	$180 - $745	82%
Humanamajor	$215 - $222	97%
Kaiser Permanentemajor	$220 - $1,028	100%
Ambetter (Centene)	$149 - $556	68%
Amerigroup	$94 - $203	43%
CareSource	$154 - $440	70%
Clover Health	$224	102%
Health Net	$733	332%
Oscar Health	$556	252%
WellCare	$220	100%
+ 27 smaller / regional plans	$65 - $1,182

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 9 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 887), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 96116.

Insurance Before you use insurance

Call your insurance company to confirm Northside Hospital Duluth is in-network.
Ask your insurer whether prior approval is required for CPT code 96116.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Northside Hospital Duluth

Compare: Neurobehavioral status check at other GA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.