CMS Price Transparency Data

Neurobehavioral status check

Facility: Boston Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $513
Cash Discount Price: $437
vs. Medicare Baseline: 2.33x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Boston Medical Center is $513. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $437. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 2.33x the Medicare baseline. Located in 1 Boston Medical Center Place, Boston, MA.

Cash / Self-Pay

$437

Average discount available for prompt cash payment at this facility.

Insurance Median

$513

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$220.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $220.6 (100%)

Cash / Self-Pay: $437 (198%)

Insurance Median: $513 (233%)

Cash: $437 (198% of Medicare)

Ins. Median: $513 (233% of 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 233% of the Medicare baseline (a markup of 133%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Medicaid / KanCare	$349	158%
Tufts [8002]	$349 - $814	158%
Uphams Corner Esp [1213]	$388	176%
Workers Comp [5002]	$416	189%
Zzzbu Employee Work Comp [5004]	$416	189%
Zzzcity Of Boston Work Comp [5003]	$416	189%
Tufts Conncare/Qhp [8020]	$431	195%
Aetna	$474	215%
Meritain Health [1023]	$474	215%
Hsn Bad Debt [4003]	$513	233%
Hsn Confidential [4007]	$513	233%
Hsn Dental [4006]	$513	233%
Hsn Partial [4002]	$513	233%
Hsn [4001]	$513	233%
Mass General Brigham Health Plan Commercial [8009]	$523	237%
Harvard Pilgrim Health Care [8001]	$620	281%
Health Plans Inc [2027]	$620	281%
United [2025]	$620	281%
Zzzhealth Plans Inc [1013]	$620	281%
Zzzunited [1008]	$620	281%
Unicare [8004]	$728	330%
Wellpoint [2034]	$728	330%
Cigna	$814 - $824	369%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $437.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 96116.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Boston Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 96116.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.