CMS Price Transparency Data

Neurobehavioral status check

Facility: Elmhurst Hospital Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 96116
  • Insurance Median: $199
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 0.90x Medicare
The contracted insurance negotiated median rate for a Neurobehavioral status check at Elmhurst Hospital Center is $199. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.90x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$199

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%)
Insurance Median: $199 (90%)
Ins. Median: $199 (90% 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.

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
Healthfirst $67 - $439 30%
Carelon $69 - $195 31%
Aetna $74 - $257 34%
Wellcare $91 41%
United Behavioral Health $111 - $215 50%
United $159 - $244 72%
Blue Cross Blue Shield $168 - $439 76%
Metroplus $179 - $439 81%
Oxford $184 83%
Amidacare $195 88%
Fidelis $195 - $523 88%
Senior Whole Health $195 88%
Affinity $199 - $439 90%
Carelon (Amida Care) $199 90%
Vnsny $199 - $368 90%
Emblem $244 - $264 111%
Elderplan $368 167%
Vaccn $368 167%
Centers Plan For Healthy Living $383 174%
Centerlight $412 187%
Oscar $553 251%
Cigna $618 280%
Magnacare $618 280%
Multiplan $659 299%
Local 1199 $700 317%
Villagecare Max $700 317%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 79-01 Broadway, Elmhurst, NY 11373
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Government - Local
  • Hospital Type: Acute Care Hospitals