CMS Price Transparency Data

Neurobehavioral status check

Facility: UNM Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $208
Cash Discount Price: $243
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at UNM Hospital is $208. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $243. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.94x the Medicare baseline. Located in 2211 Lomas Boulevard Ne, Albuquerque, NM.

Cash / Self-Pay

$243

Average discount available for prompt cash payment at this facility.

Insurance Median

$208

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: $243 (110%)

Insurance Median: $208 (94%)

Cash: $243 (110% of Medicare)

Ins. Median: $208 (94% 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
Blue Cross Blue Shield	$61 - $213	28%
Humana	$77 - $191	35%
Aetna	$85 - $213	39%
Alamo Navajo School Board	$85 - $213	39%
Indian Health Abq	$85 - $213	39%
Kewa Pueblo Health Corporation	$85 - $213	39%
Pueblo Of Isleta	$85 - $213	39%
Pueblo Of Jemez	$85 - $213	39%
Pueblo Of Sandia	$85 - $213	39%
UnitedHealthcare	$85 - $213	39%
Devoted Health	$102 - $255	46%
Christus	$128 - $319	58%
Albuquerque Public Schools	$170 - $425	77%
Presbyterian Network	$170 - $425	77%
Christus Health Exchange Plan	$191 - $479	87%
Imperial Health Exchange	$208 - $521	94%
Molina	$208 - $521	94%

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 $243.
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 UNM 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.