CMS Price Transparency Data

Neurobehavioral status check

Facility: Fairfield Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $6,099
Cash Discount Price: Unavailable
vs. Medicare Baseline: 27.65x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Fairfield Medical Center is $6,099. 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 27.65x the Medicare baseline. Located in 401 North Ewing Street, Lancaster, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,099

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: $6,099 (2765%)

Ins. Median: $6,099 (2765% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 2765% of the Medicare baseline (a markup of 2665%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Medicaid / KanCare	$191	87%
Molina	$191 - $10,067	87%
UnitedHealthcare	$191 - $6,101	87%
Caresource	$193 - $7,931	87%
Blue Cross Blue Shield	$197 - $26,250	89%
Humana	$199 - $5,980	90%
Amerihealth Caritas Ohio	$201	91%
Buckeye Community Health	$201 - $9,457	91%
Aetna	$5,980	2711%
Medical Mutual	$5,980 - $33,500	2711%
Medicare (plans)	$5,980	2711%
The Health Plan	$6,099	2765%
Valor Health Plan	$6,099	2765%
Medigold	$6,101	2766%
Va Ccn	$6,101	2766%
Oscar	$6,278	2846%
Bwc	$8,474	3841%

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 $X.
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 Fairfield 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.