CMS Price Transparency Data

Neurobehavioral status check

Facility: Mt Sinai Hospital Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 96116
  • Insurance Median: $242
  • Cash Discount Price: $452
  • vs. Medicare Baseline: 1.10x Medicare
The contracted insurance negotiated median rate for a Neurobehavioral status check at Mt Sinai Hospital Medical Center is $242. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $452. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.10x the Medicare baseline. Located in 15Th Street at California, Chicago, IL.
Cash / Self-Pay
$452

Average discount available for prompt cash payment at this facility.

Insurance Median
$242

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: $452 (205%)
Insurance Median: $242 (110%)
Cash: $452 (205% of Medicare)
Ins. Median: $242 (110% 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.

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
Partners In Hlth - All Plans $90 - $426 41%
Blue Cross Blue Shield $101 - $911 46%
Compsych Ip/Op Only - All Plans $136 - $639 62%
Healthlink Hmo $147 - $692 67%
Hfn Platinum $147 - $692 67%
Healthlink Ppo - All Other Plans $158 - $746 72%
Multiplan Primary Ntwrk/Phcs - All Other Plans $158 - $746 72%
Hfn Epo $181 - $852 82%
Multiplan Complementary Ntwrk $181 - $852 82%
UnitedHealthcare $196 - $231 89%
Hfn Ppo - All Other Plans $199 - $937 90%
Cigna $218 - $1,846 99%
Tricare $224 102%
Va Healthnet - All Plans $224 102%
Advocate Physician Prtnrs Mcr $231 105%
Cenpatico Illinicare Dual $231 105%
Cenpatico Illinicare Mcr - All Other Plans $231 105%
Humana $231 - $3,345 105%
Lawndale Christian - All Plans $231 105%
Meridian/Harmony D-Snp - All Plans $231 105%
Nextlevel Hlth Icp Fhp Aca - All Plans $231 105%
Ambetter / Centene $237 - $1,118 107%
Harmony Behavioral Htlh - All Plans $238 108%
Zing Mcr Adv - All Plans $241 109%
Molina Mcr - All Other Plans $243 110%
Oscar - All Plans $249 - $1,172 113%
Advocate Physician Prtnrs - All Other Plans $255 116%
Aetna $511 - $2,407 232%
Family Health Network Mcaid - All Plans $911 413%
Molina Mcaid $957 434%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 15Th Street at California, Chicago, IL 60608
  • CMS Rating: ★☆☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals