CMS Price Transparency Data

Neurobehavioral status check

Facility: Covenant Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $121
Cash Discount Price: $188
vs. Medicare Baseline: 0.55x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Covenant Medical Center is $121. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $188. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.55x the Medicare baseline. Located in 1447 N Harrison, Saginaw, MI.

Cash / Self-Pay

$188

Average discount available for prompt cash payment at this facility.

Insurance Median

$121

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: $188 (85%)

Insurance Median: $121 (55%)

Cash: $188 (85% of Medicare)

Ins. Median: $121 (55% 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
Health Advantage Mclaren Employee	$43 - $147	19%
Priority Health E	$44 - $123	20%
Physicians Health Plan	$53 - $147	24%
Priority Health	$53 - $221	24%
Aetna	$72 - $221	33%
Blue Cross Blue Shield	$72 - $126	33%
Health Alliance Plan Of Michigan	$72 - $426	33%
Healthy Michigan Mclaren	$72 - $115	33%
Healthy Michigan Meridian	$72 - $115	33%
Healthy Michigan Molina	$72 - $115	33%
Healthy Michigan Priority Health	$72 - $115	33%
Humana	$72 - $221	33%
Mclaren Advantage	$72 - $221	33%
Molina Healthplan	$72 - $221	33%
Physicians Health Plan Advantage/Advantage Plus	$72 - $221	33%
Meritain Health	$73 - $205	33%
Multiplan	$86 - $241	39%
Mclaren Health Advantage	$107 - $121	49%
Blue Care Network	$110 - $221	50%
Cigna	$147	67%

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 $188.
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 Covenant 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.