Neurobehavioral status check
Facility: Kansas City Orthopaedic Institute
Billing Code: 96116 (CPT)
- CPT Billing Code: 96116
- Insurance Median: $724
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.28x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 328% of the Medicare baseline (a markup of 228%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Aetna | $279 | 126% |
| UnitedHealthcare | $279 | 126% |
| Cigna | $293 | 133% |
| Blue Cross Blue Shield | $724 | 328% |
Consumer Guidance & Cost Commentary
For the CPT code 96116, "Neurobehavioral status check," the Kansas City Orthopaedic Institute in Leawood, KS, has a negotiated rate of $724.00, which is significantly higher than the state average of $220.60 (Medicare amount). While this facility is a Physician-owned Acute Care Hospital, the data indicates that commercial payers like Blue Cross Blue Shield have a single negotiated rate of $724, whereas Aetna, UnitedHealthcare, and Cigna have rates of $279 and $293 respectively. Because the negotiated rate exceeds the cash price, patients with high-deductible plans might find it beneficial to pay out-of-pocket if the facility offers a self-pay or prompt-pay discount, as these upfront payments can sometimes be cheaper than the insurance negotiated rate.
To ensure you are getting the best possible price, it is important to verify the facility's self-pay classification before scheduling, as billing systems may default to insurance processing once a card is on file. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, you should still request an itemized billing audit to identify any errors or unbundled codes, as over 80% of hospital bills contain mistakes. Given that the facility's negotiated rates are well above the Medicare benchmark, asking for a prompt-pay discount or a self-pay rate prior to check-in is the most effective way to reduce your potential out-of-pocket costs.