CMS Price Transparency Data

Neurobehavioral status check

Facility: Prisma Health Richland Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $334
Cash Discount Price: $282
vs. Medicare Baseline: 1.51x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Prisma Health Richland Hospital is $334. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $282. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.51x the Medicare baseline. Located in 5 Medical Park, Columbia, SC.

Cash / Self-Pay

$282

Average discount available for prompt cash payment at this facility.

Insurance Median

$334

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: $282 (128%)

Insurance Median: $334 (151%)

Cash: $282 (128% of Medicare)

Ins. Median: $334 (151% 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	$67 - $94	30%
UnitedHealthcare	$67 - $1,380	30%
Humana	$79 - $326	36%
Prisma Health Seniorcare Pace - Midlands [5400]	$101	46%
Prisma Health Seniorcare Pace-Upstate [5200]	$101	46%
Promise Health Plan Contracted [2401]	$152 - $260	69%
Orangeburg Senior Helping Center Pace [5401]	$174	79%
Bob Jones Univ-Pai [821]	$260	118%
Aetna	$278 - $343	126%
Meritain Health Contracted [2200]	$278 - $343	126%
Cigna	$301	136%
Evernorth Behavioral Contracted [2982]	$301	136%
Preferred Administrators Contracted [2839]	$304	138%
Medcost [2940]	$321 - $360	146%
Atlantic Packaging Contracted [4833]	$326	148%
Nippon [2300]	$343	155%
Aps Healthcare System [2981]	$347	157%
Multiplan/Phcs Contracted [2950]	$386	175%
Vsp Vision Care [2986]	$391	177%
First Health Contracted [2952]	$404	183%
Furman Int/Allen University Student [2951]	$404	183%
Quiktrip-First Health [3067]	$404	183%
Bluechoice [810]	$481 - $613	218%
Blue Cross Blue Shield	$520 - $1,061	236%
Sc Dept Of Corrections [2998]	$520	236%
Scdc-Sc Dept Of Corrections [7232]	$520	236%
Planned Administrators [820]	$1,061	481%
Golden Rule Insurance Company [2991]	$1,380	626%
Oxford Health Plans [2992]	$1,380	626%
Zzumr-Salt Lake City Ut [3169]	$1,380	626%

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 $282.
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 Prisma Health Richland 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.