Neurobehavioral status check
Facility: Memorial Hospital
Billing Code: 96116 (CPT)
- CPT Billing Code: 96116
- Insurance Median: $74
- Cash Discount Price: $217
- vs. Medicare Baseline: 0.34x 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 |
|---|---|---|
| Tricare | $70 | 32% |
| Ambetter / Centene | $77 | 35% |
Consumer Guidance & Cost Commentary
For the CPT code 96116, "Neurobehavioral status check," Memorial Hospital in Abilene, KS, lists a cash price of $217.00, which matches the cash median for this service. This cash rate is significantly lower than the facility's negotiated rates for Tricare ($70) and Ambetter/Centene ($77), illustrating a common pricing dynamic where paying out-of-pocket can be more cost-effective than using insurance for this specific procedure. While the facility is a Critical Access Hospital owned by a Government Hospital District, patients should verify their specific plan details, as commercial negotiated rates often include administrative overhead that can make them higher than the direct cash price.
To ensure you are receiving the most accurate pricing, it is important to request an itemized bill rather than accepting a summary invoice, as hospitals may obscure individual charges. Additionally, since Medicare rates for this service are $220.60, the cash price of $217.00 represents a fair value that aligns closely with the federal benchmark, avoiding the potential for excessive markups found in some commercial contracts. Before scheduling, we recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed if you choose to pay in full upfront.