Neurobehavioral status check
Facility: University Of Kansas Hospital
Billing Code: 96116 (CPT)
- CPT Billing Code: 96116
- Insurance Median: $359
- Cash Discount Price: $115
- vs. Medicare Baseline: 1.63x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Larned State Hospital [503200090] | $170 | 77% |
| Hchsync Centrus Health Direct [503999916] | $173 - $202 | 78% |
| Blue Cross Blue Shield | $222 - $443 | 101% |
| Alt Theramatrix [5032000967] | $238 | 108% |
| Health Plan Inc [503999941] | $271 | 123% |
| Accarent Health [503999034] | $288 | 131% |
| Humana | $288 | 131% |
| Alt Carelon Behavioral Health [503200905] | $288 | 131% |
| Tricare | $288 | 131% |
| Coresource [503200089] | $298 | 135% |
| Aetna | $298 - $390 | 135% |
| Meritain Health [503200039] | $298 - $485 | 135% |
| Coventry [503200022] | $298 - $390 | 135% |
| UnitedHealthcare | $321 | 146% |
| Geha [503200036] | $321 - $350 | 146% |
| Workers Comp [503999901] | $321 - $548 | 146% |
| Medica [503200074] | $321 | 146% |
| Allied National [503999937] | $346 | 157% |
| Php [503200005] | $346 - $426 | 157% |
| Med-Pay [503200040] | $350 | 159% |
| Healthlink [503200007] | $350 - $426 | 159% |
| Cerner [503200038] | $350 | 159% |
| Alt Wppa [5032000964] | $350 | 159% |
| Inter-Americas Insurance [503999032] | $350 | 159% |
| Alt Coventry Advantra Mhnet [50311260] | $352 | 160% |
| Mh Net [503999024] | $352 | 160% |
| Alt Coventry Mhnet [503200030] | $352 | 160% |
| Cigna | $366 - $462 | 166% |
| Aha-Healthcare Preferred [503200050] | $380 | 172% |
| First Health [5032000110] | $380 | 172% |
| Alt Meritain Health [503999911] | $390 | 177% |
| Ascension Living Hope [503201517] | $404 | 183% |
| Consolidated Billing [50311256] | $404 | 183% |
| Correct Care Solutions [50311253] | $404 | 183% |
| Coeur Plan Services [503301517] | $404 | 183% |
| Orscheln Industries [503201608] | $433 | 196% |
| Alt Lucent Health Solutions [503202603] | $443 | 201% |
| Alt Lineco [5032000976] | $443 | 201% |
| Empire Plan/Nyship [503200705] | $443 | 201% |
| Point Comfort Underwriters [503200018] | $462 | 209% |
| Century Health Solutions [503200054] | $462 | 209% |
| Quiktrip [5032000412] | $462 | 209% |
| Triwest [503201703] | $462 | 209% |
| Wppa [503200056] | $485 | 220% |
| Three Rivers Provider Network [503999029] | $519 | 235% |
| Usa Managed Care [503999030] | $519 | 235% |
| Employers Health Network [503999025] | $519 | 235% |
| Plan Care America [503999026] | $519 | 235% |
| Sanford Health Plan [503999027] | $519 | 235% |
Consumer Guidance & Cost Commentary
For the CPT code 96116, "Neurobehavioral status check," the University of Kansas Hospital in Kansas City, KS, lists a gross charge of $577.00. While the facility's cash price is $115.00, commercial insurance negotiated rates range from $170 to $519 across 49 payers, with a median negotiated amount of $359.00. This data indicates that for patients with high-deductible plans, paying the cash price of $115.00 upfront may result in significant savings compared to the insurance allowed amount, provided the patient meets their deductible. It is important to note that the facility is an Acute Care Hospital owned by a Government Hospital District, and patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not billed the full negotiated rate.
The facility's pricing structure warrants attention regarding balance billing and itemized billing audits. Although the No Surprises Act generally protects patients from balance billing for out-of-network services at in-network facilities, patients should verify that all ancillary services, such as specific laboratory tests or emergency physician services, are covered under the same network agreement to avoid unexpected secondary bills. Furthermore, since over 80% of hospital bills contain errors, patients should never accept a summary bill as final; instead, they should demand a full itemized CPT-coded statement to identify unbundled codes or services not rendered. When evaluating the value of this service, it is more accurate to compare the facility's rates against the Medicare benchmark of $220.60 rather than the gross chargemaster, as commercial rates often