CMS Price Transparency Data

Neurobehavioral status check

Facility: St Luke's Warren Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $389
Cash Discount Price: $1,307
vs. Medicare Baseline: 1.76x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at St Luke's Warren Hospital is $389. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,307. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.76x the Medicare baseline. Located in 185 Roseberry St, Phillipsburg, NJ.

Cash / Self-Pay

$1,307

Average discount available for prompt cash payment at this facility.

Insurance Median

$389

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: $1,307 (592%)

Insurance Median: $389 (176%)

Cash: $1,307 (592% of Medicare)

Ins. Median: $389 (176% 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
Geisinger	$81 - $408	37%
Amerihealth Caritas	$82	37%
UPMC Health Plan	$82 - $398	37%
Blue Cross Blue Shield	$341 - $1,359	155%
UnitedHealthcare	$343 - $392	155%
Aetna	$350 - $507	159%
Humana	$357	162%
Oscar	$378	171%
Cigna	$395	179%

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 $1,307.
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 St Luke's Warren Hospital 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.