CMS Price Transparency Data

Neurobehavioral status check

Facility: Physicians Care Surgical Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 96116
  • Insurance Median: $415
  • Cash Discount Price: $332
  • vs. Medicare Baseline: 1.88x Medicare
The contracted insurance negotiated median rate for a Neurobehavioral status check at Physicians Care Surgical Hospital is $415. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $332. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.88x the Medicare baseline. Located in 454 Enterprise Drive, Royersford, PA.
Cash / Self-Pay
$332

Average discount available for prompt cash payment at this facility.

Insurance Median
$415

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: $332 (150%)
Insurance Median: $415 (188%)
Cash: $332 (150% of Medicare)
Ins. Median: $415 (188% 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.

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
Connecticare $278 126%
Aetna $306 - $465 139%
Ag Administrators $306 139%
Ag Administrators Inc $306 139%
Allied Benefit Systems $306 139%
Allied Benefits Systems $306 139%
Continental Benefits $306 139%
Coventry $306 139%
Geha $306 139%
Healthez $306 139%
Lucent Health $306 139%
Marpai Health $306 139%
Meritain Health $306 139%
Premier Care Network $306 139%
Trustmark $306 139%
Aarp $415 188%
Blue Cross Blue Shield $415 - $554 188%
Cigna $415 188%
Devon Health Services $415 188%
Gpm Health And Life Insurance Mc Supplement $415 188%
Humana $415 188%
Ibc Security 65 $415 188%
Keystone 65 Hmo $415 188%
Medicare (plans) $415 188%
Pcsh Aarp $415 188%
Personal Choice 65 $415 188%
Shenandoah Life $415 188%
Tricare $415 188%
Unified Health Services $415 188%
UnitedHealthcare $415 - $880 188%
Vibra Health Plan $415 188%
Amerihealth Administrators $448 203%
Amerihealth New Jersey Hmo $448 203%
Carefirst Administrators $448 203%
Empire Plan $448 203%
Horizon Of New Jersey $448 203%
Ibc $448 203%
Ibc - Local $448 203%
Ibc 2021 $448 203%
Ibc Local $448 203%
Independence Administrators $448 203%
Independence Bc $448 203%
Independence Federal $448 203%
Keystone Direct Pos $448 203%
Keystone Healthplan East $448 203%
Keystone Hmo $448 203%
Pcsh Ibc $448 203%
Personal Choice $448 203%
Regence Blue Shield $448 203%
Highmark $554 251%
Allsavers $880 399%
Golden Rule Op $880 399%
Oxford Health Plan $880 399%
Oxford Life Insurance Company $880 399%
Surest $880 399%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 454 Enterprise Drive, Royersford, PA 19468
  • CMS Rating: No CMS Rating
  • Ownership Type: Physician
  • Hospital Type: Acute Care Hospitals