CMS Price Transparency Data

Neurobehavioral status check

Facility: Loyola Gottlieb Memorial Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $282
Cash Discount Price: $68
vs. Medicare Baseline: 1.28x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Loyola Gottlieb Memorial Hospital is $282. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.28x the Medicare baseline. Located in 701 West North Ave, Melrose Park, IL.

Cash / Self-Pay

$68

Average discount available for prompt cash payment at this facility.

Insurance Median

$282

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: $68 (31%)

Insurance Median: $282 (128%)

Cash: $68 (31% of Medicare)

Ins. Median: $282 (128% 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
Cigna	$108 - $334	49%
Aetna	$158 - $325	72%
Blue Cross Blue Shield	$166 - $302	75%
UnitedHealthcare	$215 - $254	97%
Humana	$319 - $332	145%
Vaccn United	$325	147%
Ambetter / Centene	$341	155%
Molina	$341 - $604	155%
Wellcare	$341	155%
Oscar Ifp	$357	162%
Meridian	$377 - $604	171%
Molina Marketplace Ifp	$406	184%

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 $68.
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 Loyola Gottlieb Memorial 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.