CMS Price Transparency Data

Neurobehavioral status check

Facility: Maimonides Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $289
Cash Discount Price: $650
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Maimonides Medical Center is $289. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $650. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.31x the Medicare baseline. Located in 4802 Tenth Avenue, Brooklyn, NY.

Cash / Self-Pay

$650

Average discount available for prompt cash payment at this facility.

Insurance Median

$289

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: $650 (295%)

Insurance Median: $289 (131%)

Cash: $650 (295% of Medicare)

Ins. Median: $289 (131% 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
Local 1199	$97	44%
Healthfirst	$264	120%
Aetna	$270	122%
Carelon Behavioral Health	$289	131%
United Community Plan	$296	134%
Metroplus	$323	146%
Blue Cross Blue Shield	$349	158%
Emblem Health - Ghi	$819	371%

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 $650.
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 Maimonides 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.