CMS Price Transparency Data

Neurobehavioral status check

Facility: Saint Clare's Hospital/ Denville Campus

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $300
Cash Discount Price: $250
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Saint Clare's Hospital/ Denville Campus is $300. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $250. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.36x the Medicare baseline. Located in 25 Pocono Road, Denville, NJ.

Cash / Self-Pay

$250

Average discount available for prompt cash payment at this facility.

Insurance Median

$300

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: $250 (113%)

Insurance Median: $300 (136%)

Cash: $250 (113% of Medicare)

Ins. Median: $300 (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
Horizon	$49 - $521	22%
Amerihealth	$82 - $250	37%
Ubh	$86	39%
UnitedHealthcare	$86 - $648	39%
Humana	$200	91%
Aetna	$250 - $531	113%
Clover Health	$250	113%
Medicare (plans)	$250	113%
Tricare	$250	113%
Wellcare	$250 - $338	113%
Wellpoint Amerigroup	$250	113%
Ally-Align (Fka Spartan Health Plan)	$263	119%
Employer Direct Healthcare	$351	159%
Cigna	$387	175%
Fairprice Healthcare Holdings - Fphh	$401	182%
Coventry	$501	227%

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 $250.
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 Saint Clare's Hospital/ Denville 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.