CMS Price Transparency Data

Neurobehavioral status check

Facility: Harlem Hospital Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 96116
  • Insurance Median: $214
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 0.97x Medicare
The contracted insurance negotiated median rate for a Neurobehavioral status check at Harlem Hospital Center is $214. 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 0.97x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$214

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: $214 (97%)
Ins. Median: $214 (97% 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
United $59 - $262 27%
Healthfirst $67 - $472 30%
Carelon $69 - $210 31%
Emblem $80 - $553 36%
Amidacare $84 38%
Fidelis $84 - $523 38%
Wellcare $91 41%
Local 1199 $97 44%
United Behavioral Health $111 - $231 50%
Aetna $122 - $368 55%
Metroplus $126 - $210 57%
Blue Cross Blue Shield $210 - $472 95%
Senior Whole Health $210 95%
Affinity $214 - $472 97%
Carelon (Amida Care) $214 97%
Vnsny $214 - $368 97%
Vaccn $368 167%
Centers Plan For Healthy Living $383 174%
Oscar $553 251%
Elderplan $737 334%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 506 Lenox Avenue, New York, NY 10037
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Other
  • Hospital Type: Acute Care Hospitals