CMS Price Transparency Data

Neurobehavioral status check

Facility: Cannon Memorial Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $92
Cash Discount Price: $110
vs. Medicare Baseline: 0.42x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Cannon Memorial Hospital is $92. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $110. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.42x the Medicare baseline. Located in 123 W G Acker Drive, Pickens, SC.

Cash / Self-Pay

$110

Average discount available for prompt cash payment at this facility.

Insurance Median

$92

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: $110 (50%)

Insurance Median: $92 (42%)

Cash: $110 (50% of Medicare)

Ins. Median: $92 (42% 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
Aetna	$73 - $117	33%
Blue Choice Health Plan [922]	$73 - $128	33%
Blue Cross Blue Shield	$73 - $116	33%
Medicare (plans)	$73 - $87	33%
UnitedHealthcare	$73 - $126	33%
Vaccn - Va Community Care Network [16]	$73	33%
Veterans Administration [633]	$73	33%
Devoted Health Alt Payer [9401]	$74	34%
Devoted Health [94]	$74	34%
Humana	$74 - $252	34%
Cigna	$75 - $131	34%
Molina Dual Options Alt Payer [1501]	$75	34%
Molina Dual Options [15]	$75	34%
Absolute Total Care Mcr Plans Alt Payer [4101]	$76	34%
Absolute Total Care Mcr Plans [41]	$76	34%
Champva [604]	$77	35%
First Choice Vip Careplus Alt Payer [3301]	$77	35%
First Choice Vip [33]	$77	35%
Nhc Advantage Alt Payer [6101]	$77	35%
Nhc Advantage [61]	$77	35%
Tricare	$77	35%
Bright Health Alt Payer [1001]	$87	39%
Planned Administrators [886]	$92	42%
Thomas Cooper & Company [315]	$92	42%
Ambetter / Centene	$104	47%
Employee Benefit Management Services [869]	$106	48%
First Choice Next [96]	$106	48%
Molina Marketplace [97]	$106	48%
Bright Health [11]	$109	49%
Mail Handlers Benefit Plan [327]	$117	53%
Rural Carrier Benefit Plan [406]	$117	53%
Workers Compensation [622]	$119	54%
Geha [302]	$126	57%
Golden Rule Ins Co [584]	$126	57%
Edison Health Solutions [95]	$128	58%
Healthscope [98]	$128	58%
Nalc Health Benefit Plan [291]	$131	59%
Preferred Administrators [19]	$132	60%
Medcost [206]	$147	67%
Phcs [940]	$194	88%

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 $110.
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 Cannon Memorial 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.