CMS Price Transparency Data

Neurobehavioral status check

Facility: Independence Health System Butler Memorial Hospita

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

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

The contracted insurance negotiated median rate for a Neurobehavioral status check at Independence Health System Butler Memorial Hospita is $313. 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 1.42x the Medicare baseline. Located in One Hospital Way, Butler, PA.

Cash / Self-Pay

Unavailable

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%)

Insurance Median: $313 (142%)

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
Medicaid / KanCare	$69	31%
UnitedHealthcare	$69 - $768	31%
Behavioral	$70	32%
Geisinger	$75 - $315	34%
Amerihealth	$76 - $315	34%
Jefferson Health Plan	$76	34%
Gateway	$78 - $336	35%
Upmc	$78 - $422	35%
Ccbh - Behavioral Health	$171	78%
Pnoa	$182 - $330	83%
Workers Comp	$275	125%
Highmark	$294 - $632	133%
Life Butler County	$300	136%
Martin'S Point - Usfhp	$300	136%
Medicare (plans)	$300	136%
Peak Health	$300 - $704	136%
Provider Partners	$300	136%
Tricare	$300	136%
Aetna	$309 - $689	140%
Humana	$312	141%
Devoted Health Plan	$318	144%
The Health Plan	$318 - $704	144%
Pa Health & Wellness	$321	146%
American Health Plan	$330	150%
Highmark Aca - Direct Blue	$395	179%
Ellwood Group	$599	272%
Highmark Community Blue	$620	281%
Cigna	$684	310%
Highmark - Ind.& Managed Care	$702	318%

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 Independence Health System Butler Memorial Hospita 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.