CMS Price Transparency Data

Neurobehavioral status check

Facility: Saint Anthony Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $475
Cash Discount Price: $307
vs. Medicare Baseline: 2.15x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Saint Anthony Hospital is $475. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $307. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 2.15x the Medicare baseline. Located in 2875 West 19Th Street, Chicago, IL.

Cash / Self-Pay

$307

Average discount available for prompt cash payment at this facility.

Insurance Median

$475

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: $307 (139%)

Insurance Median: $475 (215%)

Cash: $307 (139% of Medicare)

Ins. Median: $475 (215% 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 215% of the Medicare baseline (a markup of 115%). 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
Access Community Health Network	$276 - $353	125%
Aetna	$325 - $767	147%
Blue Cross Blue Shield	$325 - $477	147%
Cigna	$325 - $512	147%
Humana	$325	147%
Oak Street Health	$325	147%
UnitedHealthcare	$325	147%
Zing Health	$325	147%
Healthlink	$511 - $614	232%
Healthsmart	$596 - $716	270%
Galaxy Health Network	$681 - $818	309%
Prime Health	$681 - $818	309%
Zelis Healthcare	$681 - $818	309%

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 $307.
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 Saint Anthony 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.