CMS Price Transparency Data

Neurobehavioral status check

Facility: Saint Vincent Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $95
Cash Discount Price: $40
vs. Medicare Baseline: 0.43x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Saint Vincent Hospital is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $40. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.43x the Medicare baseline. Located in 232 West 25Th Street, Erie, PA.

Cash / Self-Pay

$40

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $40 (18%)

Insurance Median: $95 (43%)

Cash: $40 (18% of Medicare)

Ins. Median: $95 (43% 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
Community Care Behavorial Health Healthchoices	$60	27%
Community Care Behavorial Health University Of Pittsburgh Medical Center	$60	27%
Univera	$66 - $97	30%
Highmark	$69 - $494	31%
Amerihealth	$72 - $356	33%
Life Pittsburgh	$74 - $339	34%
Carelon	$75	34%
Medicare (plans)	$79 - $349	36%
American Health Plans	$82 - $339	37%
Pennsylvania Health And Wellness	$91	41%
Geisinger	$100	45%
UnitedHealthcare	$100 - $9,151	45%
Cigna	$128 - $723	58%
Martin'S Point	$232 - $339	105%
University Of Pittsburgh Medical Center	$339	154%
Aetna	$352 - $690	160%
Blue Cross Blue Shield	$356 - $534	161%
Highmark Wholecare	$359	163%
Humana	$359	163%
Molina	$369	167%
Medical Mutual	$723	328%

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 $40.
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 Saint Vincent Hospital 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.