CMS Price Transparency Data

Neurobehavioral status check

Facility: Community First Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $231
Cash Discount Price: $113
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Community First Medical Center is $231. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.05x the Medicare baseline. Located in 5645 W Addison Street, Chicago, IL.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$231

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: $113 (51%)

Insurance Median: $231 (105%)

Cash: $113 (51% of Medicare)

Ins. Median: $231 (105% 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
Blue Cross Blue Shield	$62 - $712	28%
Aetna	$68 - $733	31%
Cigna	$72 - $156	33%
Humana	$113 - $912	51%
UnitedHealthcare	$127	58%
Beacon Mcr Op Only - All Other Plans	$231	105%
Harmony Mcr Adv - All Other Plans	$231	105%
Meridian Mcr Adv - All Other Plans	$231	105%
Molina Marketplace - All Other Plans	$231	105%
Molina Mcr Adv	$231	105%
Zing Hlth Mcr Adv - All Plans	$231	105%
Beacon Mcaid Op Only	$733	332%
Cchhs Mcaid	$733	332%
County Care Mcaid - All Plans	$733	332%
Harmony Mcaid	$733	332%
Meridian Mcaid	$733	332%
Molina Mcaid	$733	332%

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 $113.
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 Community First Medical Center 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.