CMS Price Transparency Data

Neurobehavioral status check

Facility: Emerson Hospital -

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $303
Cash Discount Price: $911
vs. Medicare Baseline: 1.37x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Emerson Hospital - is $303. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $911. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.37x the Medicare baseline. Located in 133 Old Road To 9 Acre Corner, W Concord, MA.

Cash / Self-Pay

$911

Average discount available for prompt cash payment at this facility.

Insurance Median

$303

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: $911 (413%)

Insurance Median: $303 (137%)

Cash: $911 (413% of Medicare)

Ins. Median: $303 (137% 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.

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
Tufts Ppo	$199	90%
Medicare (plans)	$254 - $260	115%
Tufts Senior Care Options	$254	115%
Blue Cross Blue Shield	$255 - $414	116%
UnitedHealthcare	$255 - $1,214	116%
Medicaid / KanCare	$259	117%
Masshealth	$303	137%
Mgb Mh Aco	$303	137%
Aetna	$777	352%
Wellpoint (Formerly Unicare)	$910	413%
Cigna	$1,111	504%

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 $911.
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 Emerson Hospital - 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.