CMS Price Transparency Data

Neurobehavioral status check

Facility: Novant Health Presbyterian Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $591
Cash Discount Price: $477
vs. Medicare Baseline: 2.68x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Novant Health Presbyterian Medical Center is $591. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $477. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 2.68x the Medicare baseline. Located in 200 Hawthorne Lane Box 33549, Charlotte, NC.

Cash / Self-Pay

$477

Average discount available for prompt cash payment at this facility.

Insurance Median

$591

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: $477 (216%)

Insurance Median: $591 (268%)

Cash: $477 (216% of Medicare)

Ins. Median: $591 (268% 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 268% of the Medicare baseline (a markup of 168%). 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
Carolina Complete	$166	75%
Nc Department Of Public Safety	$166 - $420	75%
Amerihealth	$170	77%
Blue Cross Blue Shield	$170 - $687	77%
UnitedHealthcare	$170 - $557	77%
Wellcare	$170	77%
Humana	$210 - $687	95%
Pace Of The Southern Piedmont	$210	95%
Aetna	$215 - $763	97%
Cigna	$216 - $491	98%
Liberty Health	$220	100%
Caresource North Carolina	$315	143%
Atlantic Corporation Dba Atlantic Packaging	$439	199%
Amps	$525	238%
Plotkin Health	$572	259%
Medcost	$677 - $716	307%
Primary Physician Care	$706	320%
Multiplan	$716	325%
Phcs	$716	325%
Employers Choice Network	$925	419%
Three Rivers Provider Network	$925	419%

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 $477.
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 Novant Health Presbyterian 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.