CMS Price Transparency Data

Neurobehavioral status check

Facility: Shepherd Center, Inc.

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $449
Cash Discount Price: $345
vs. Medicare Baseline: 2.04x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Shepherd Center, Inc. is $449. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $345. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 2.04x the Medicare baseline. Located in 2020 Peachtree Rd Nw, Atlanta, GA.

Cash / Self-Pay

$345

Average discount available for prompt cash payment at this facility.

Insurance Median

$449

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: $345 (156%)

Insurance Median: $449 (204%)

Cash: $345 (156% of Medicare)

Ins. Median: $449 (204% 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 204% of the Medicare baseline (a markup of 104%). 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
Blue Cross Blue Shield	$55 - $87	25%
Medicare (plans)	$80 - $296	36%
Kaiser	$92 - $107	42%
Humana	$107 - $248	49%
UnitedHealthcare	$116	53%
Cigna	$119 - $126	54%
Coventry	$120 - $449	54%
Aetna	$122 - $587	55%
Paradigm Wc	$338 - $339	153%
Secure Health	$414 - $415	188%
Coventry Wc	$448 - $449	203%
Alamed Wc	$483 - $484	219%
Fcci Wc	$483 - $484	219%
Multiplan	$518	235%
Evolution Wc	$552 - $553	250%
Prime Health Wc	$552 - $622	250%
Corvel Wc	$586 - $587	266%
Novanet Wc	$586 - $587	266%

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 $345.
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 Shepherd Center, Inc. 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.