CMS Price Transparency Data

Neurobehavioral status check

Facility: Lower Bucks Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $223
Cash Discount Price: $212
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Lower Bucks Hospital is $223. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $212. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.01x the Medicare baseline. Located in 501 Bath Road, Bristol, PA.

Cash / Self-Pay

$212

Average discount available for prompt cash payment at this facility.

Insurance Median

$223

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: $212 (96%)

Insurance Median: $223 (101%)

Cash: $212 (96% of Medicare)

Ins. Median: $223 (101% 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
UnitedHealthcare	$135 - $454	61%
Humana	$170	77%
Blue Cross Blue Shield	$212 - $568	96%
Health Partners Plan	$212 - $319	96%
Medicare (plans)	$212 - $223	96%
Pa Health & Wellness	$212 - $255	96%
Tricare	$212	96%
Provider Patners Health Plan	$219	99%
Keystone	$221	100%
Spartan Plan Pa	$223	101%
Auto Insurance	$234	106%
Worker Compensation	$240	109%
Employer Direct Healthcare	$297	135%
Highmark	$473	214%
Cigna	$513	233%

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 $212.
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 Lower Bucks 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.