CMS Price Transparency Data

Neurobehavioral status check

Facility: Cincinnati Children's Hospital Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $313
Cash Discount Price: $198
vs. Medicare Baseline: 1.42x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Cincinnati Children's Hospital Medical Center is $313. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $198. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.42x the Medicare baseline. Located in 3333 Burnet Avenue, Cincinnati, OH.

Cash / Self-Pay

$198

Average discount available for prompt cash payment at this facility.

Insurance Median

$313

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: $198 (90%)

Insurance Median: $313 (142%)

Cash: $198 (90% of Medicare)

Ins. Median: $313 (142% 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	$53 - $389	24%
Mhs_In	$53	24%
Caresource_In	$56	25%
Aetna	$66 - $389	30%
Cigna	$82 - $159	37%
Humana	$97	44%
Passport_Ky	$101	46%
Wellcare_Ky	$102	46%
United_Health_Care_Ky	$103	47%
Caresource_Oh_Insurance	$194	88%
Medical_Mutual_Of_Ohio_Insurance	$208 - $370	94%
Parkview_Signature_Care_Insurance	$208 - $301	94%
Point_Comfort_Insurance	$253	115%
Margaret_Mary_Health_Insurance	$258 - $303	117%
Health_Ohio_Network_Insurance	$311 - $370	141%
Beechstreet_Insurance	$314 - $370	142%
Health_Net_Advantage_Insurance	$331	150%
Evolutions_Health_Care_Systems	$350	159%
Custom_Design_Benefits_Insurance	$370	168%
First_Health_Group_Insurance	$370	168%
Health_Link_Insurance	$370	168%
Health_Smart_Preferred_Insurance	$370	168%
Medical_Benefit_Administrators_Insurance	$370	168%
Ohio_Health_Choice_Insurance	$370	168%
Galaxy_Health_Insurance	$389	176%
Private_Health_Care_Systems_Insurance	$389	176%
United_Health_Care_Insurance	$389	176%

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 $198.
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 Cincinnati Children's Hospital 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.