CMS Price Transparency Data

Neurobehavioral status check

Facility: Carolina East Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $175
Cash Discount Price: $150
vs. Medicare Baseline: 0.79x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Carolina East Medical Center is $175. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.79x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$175

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: $150 (68%)

Insurance Median: $175 (79%)

Cash: $150 (68% of Medicare)

Ins. Median: $175 (79% 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
Pamlico Co Jail-All Plans	$66	30%
Humana	$71	32%
Inclusive Health (Nchirp)-All Plans	$71	32%
Tricare	$71	32%
UnitedHealthcare	$88	40%
Craven Co. Jail Systems - All Plans	$154	70%
Medcost Ppo Employees And Retirees	$164	74%
Medcost Ppo Ultra (Employees)	$164	74%
Blue Cross Blue Shield	$175	79%
Medcost Ppo City Employees	$182	83%
Medcost Ppo County Employee	$189	86%
Benefit Mgmt, Svcs-All Plans	$212	96%
Medcost Benefit Svc-All Other Plans	$221	100%
Aetna	$222	101%
Acs Consult Svc Inc-All Plans	$226	102%
Medcost Ppo Standard	$226	102%
Cigna	$228	103%

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 $150.
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 Carolina East 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.