Neurobehavioral status check
Facility: Children'S Mercy South
Billing Code: 96116 (CPT)
- CPT Billing Code: 96116
- Insurance Median: $162
- Cash Discount Price: $118
- vs. Medicare Baseline: 0.73x 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 | $78 - $179 | 35% |
| Healthy Blue | $89 - $99 | 40% |
| Home State Health | $89 | 40% |
| Medicaid / KanCare | $100 | 45% |
| Healthlink | $103 | 47% |
| Health Midwest Comprehensive Care | $109 | 49% |
| Wppa Providrs Care | $110 | 50% |
| American Healthcare Alliance | $113 | 51% |
| Quiktrip | $127 | 58% |
| Medica | $143 | 65% |
| Blue Cross Blue Shield | $150 - $183 | 68% |
| Wellfit/Centrus | $151 | 68% |
| Centivo | $156 | 71% |
| Humana | $159 | 72% |
| Nebraska Furniture Mart | $159 | 72% |
| Orscheln | $161 | 73% |
| Aetna | $162 - $191 | 73% |
| Multiplan | $169 | 77% |
| Mercy Health | $179 | 81% |
| Coxhealth Network | $181 | 82% |
| Cigna | $195 | 88% |
| Coventry Health Care Of Kansas | $204 | 92% |
| National Preferred Provider Network | $216 | 98% |
Consumer Guidance & Cost Commentary
For the Neurobehavioral status check (CPT 96116) at Children's Mercy South in Overland Park, KS, the cash median price is $118.00, which is significantly lower than the facility's gross charge of $245.00. While the facility's negotiated rates with insurance payers range from $78 to $216, the cash price offers a potential savings opportunity for patients with high-deductible plans or those without insurance, as the cash rate is often lower than the insurer's allowed amount. It is important to note that commercial negotiated rates frequently exceed cash prices due to administrative overhead and contract structures; therefore, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not inadvertently paying a higher rate through insurance.
When evaluating the cost of this service, it is more accurate to compare rates against the Medicare benchmark rather than the facility's inflated chargemaster list. The Medicare amount for this code is $220.60, which serves as a scientifically validated baseline for the true cost of care. Although the specific county or state average for this procedure is not provided in the current data, patients should be aware that commercial rates often average 200% to 300% of Medicare, whereas fair pricing is typically defined as 120% to 150%. If a patient receives a bill that exceeds the Medicare rate significantly, they may be subject to balance billing if they are out-of-network, though the No Surprises Act protects against such surprise bills for emergency care and non-emergency services at in-network facilities.