CMS Price Transparency Data

Neurobehavioral status check

Facility: Boston Medical Center-Brighton

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $752
Cash Discount Price: $463
vs. Medicare Baseline: 3.41x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Boston Medical Center-Brighton is $752. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $463. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 3.41x the Medicare baseline. Located in 736 Cambridge Street, Nevins Building, Brighton, MA.

Cash / Self-Pay

$463

Average discount available for prompt cash payment at this facility.

Insurance Median

$752

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: $463 (210%)

Insurance Median: $752 (341%)

Cash: $463 (210% of Medicare)

Ins. Median: $752 (341% 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 341% of the Medicare baseline (a markup of 241%). 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
Blue Cross Blue Shield	$29 - $35	13%
Harvard Pilgrim Health Care [8001]	$360	163%
Hsn Bad Debt [4003]	$475	215%
Hsn Confidential [4007]	$475	215%
Hsn Dental [4006]	$475	215%
Hsn Partial [4002]	$475	215%
Hsn [4001]	$475	215%
Aetna	$752	341%
Meritain Health [1023]	$752	341%
Unicare [8004]	$771	350%
Wellpoint [2034]	$771	350%
Mass General Brigham Health Plan Commercial [8009]	$779	353%
Mass General Brigham Health Plan Prime [7003]	$779	353%
Tufts [8002]	$900 - $1,022	408%
Cigna	$1,022	463%

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 $463.
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-Brighton 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.