Neurobehavioral status check
Facility: Community Memorial Healthcare, Inc.
Billing Code: 96116 (CPT)
- CPT Billing Code: 96116
- Insurance Median: $116
- Cash Discount Price: $145
- vs. Medicare Baseline: 0.53x 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 |
|---|---|---|
| Aetna | $67 - $116 | 30% |
| UnitedHealthcare | $265 | 120% |
Consumer Guidance & Cost Commentary
For the CPT code 96116, "Neurobehavioral status check," Community Memorial Healthcare, Inc. in Marysville, KS, lists a cash price of $145.00, which matches the facility's median paid amount. This cash rate is significantly lower than the Medicare benchmark of $220.60, indicating a markup of 50% above the federal baseline. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. For instance, UnitedHealthcare's single plan negotiates a rate of $265.00, which is substantially higher than the cash price, whereas Aetna's two plans negotiate a range between $67.00 and $116.00. In this specific case, the cash price of $145.00 falls within the Aetna negotiated range, potentially offering a more affordable option for those with high-deductible plans who have not yet met their coverage thresholds.
To maximize savings, patients should verify whether their specific insurance plan negotiates a rate lower than the cash price before scheduling, as commercial contracts can vary widely even within the same network. It is important to ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid upfront, bypassing the costly claims processing cycle that inflates insurance rates. Additionally, since over 80% of hospital bills contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill, and dispute any charges for services