CMS Price Transparency Data

Neurobehavioral status check

Facility: Wakemed, Raleigh Campus

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $301
Cash Discount Price: $201
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Wakemed, Raleigh Campus is $301. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $201. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.36x the Medicare baseline. Located in 3000 New Bern Ave, Raleigh, NC.

Cash / Self-Pay

$201

Average discount available for prompt cash payment at this facility.

Insurance Median

$301

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: $201 (91%)

Insurance Median: $301 (136%)

Cash: $201 (91% of Medicare)

Ins. Median: $301 (136% 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
Amerihealth	$95	43%
Carolina Complete	$95	43%
Wellcare	$95 - $301	43%
Blue Cross Blue Shield	$124 - $301	56%
Ambetter / Centene	$132 - $191	60%
Cigna	$155 - $269	70%
Aetna	$238 - $359	108%
First Health	$243 - $465	110%
Liberty	$307	139%
Pruitt	$307	139%
Alignment	$316	143%
Medcost	$380 - $396	172%
Phcs	$422	191%
Multiplan	$475	215%

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 $201.
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 Wakemed, Raleigh Campus 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.