Neurobehavioral status check
Facility: Wesley Medical Center
Billing Code: 96116 (CPT)
- CPT Billing Code: 96116
- Insurance Median: $92
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.42x 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 |
|---|---|---|
| UnitedHealthcare | $89 | 40% |
| Medicaid / KanCare | $92 | 42% |
| Amerigroup | $93 | 42% |
| Aetna | $93 | 42% |
Consumer Guidance & Cost Commentary
For the CPT code 96116, "Neurobehavioral status check," the negotiated rates at Wesley Medical Center in Wichita, KS, range from $89 to $93 across four major payers, including UnitedHealthcare, Medicaid/KanCare, Amerigroup, and Aetna. These contracted amounts align closely with the facility's median negotiated rate of $92.00. While the facility is an Acute Care Hospital with a Proprietary ownership structure, the data does not provide specific cash or self-pay prices for this service. In cases where a patient has a high deductible or limited insurance coverage, the cash price could theoretically be lower than the insurance negotiated rate, potentially resulting in lower out-of-pocket costs if the patient qualifies for a self-pay or prompt-pay discount.
It is important to note that commercial insurance rates often differ significantly from Medicare benchmarks; in this instance, the Medicare amount for this procedure is $220.60, which serves as a federal cost baseline for evaluating pricing fairness. Commercial negotiated rates frequently exceed Medicare amounts due to administrative overhead and contract dynamics, though fair pricing is often defined as 120% to 150% of the Medicare rate. Patients should be aware that balance billing is generally prohibited for in-network services under the No Surprises Act, meaning the facility cannot bill the patient for the difference between the chargemaster and the allowed amount. To ensure transparency and minimize unexpected costs, patients are encouraged to request a full itemized bill before payment and to verify their specific plan's deductible status, as paying the negotiated rate may not be necessary if the patient has not yet met their annual out-of-pocket maximum.