CMS Price Transparency Data

Neurobehavioral status check

Facility: Prisma Health Hillcrest Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $330
Cash Discount Price: $288
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Prisma Health Hillcrest Hospital is $330. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $288. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.50x the Medicare baseline. Located in 741 South East Main Street, Simpsonville, SC.

Cash / Self-Pay

$288

Average discount available for prompt cash payment at this facility.

Insurance Median

$330

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: $288 (131%)

Insurance Median: $330 (150%)

Cash: $288 (131% of Medicare)

Ins. Median: $330 (150% 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
First Choice Benefits Mgmt [3074]	$63	29%
Medicaid / KanCare	$63 - $68	29%
Medicare (plans)	$63	29%
Humana	$67	30%
UnitedHealthcare	$68 - $1,047	31%
Prisma Health Seniorcare Pace - Midlands [5400]	$103	47%
Prisma Health Seniorcare Pace-Upstate [5200]	$103	47%
Promise Health Plan Contracted [2401]	$155 - $266	70%
Orangeburg Senior Helping Center Pace [5401]	$177	80%
Bob Jones Univ-Pai [821]	$266	121%
Aetna	$284 - $350	129%
Meritain Health Contracted [2200]	$284 - $350	129%
Cigna	$307	139%
Evernorth Behavioral Contracted [2982]	$307	139%
Mvp Health Care [3037]	$307	139%
Preferred Administrators Contracted [2839]	$310	141%
Medcost [2940]	$328 - $368	149%
Atlantic Packaging Contracted [4833]	$332	150%
Aps Healthcare System [2981]	$354	160%
Blue Cross Blue Shield	$389 - $899	176%
Multiplan/Phcs Contracted [2950]	$394	179%
Vsp Vision Care [2986]	$399	181%
First Health Contracted [2952]	$412	187%
Furman Int/Allen University Student [2951]	$412	187%
Quiktrip-First Health [3067]	$412	187%
Bluechoice [810]	$464 - $949	210%
Sc Dept Of Corrections [2998]	$520	236%
Scdc-Sc Dept Of Corrections [7232]	$520	236%
Planned Administrators [820]	$899	408%
Golden Rule Insurance Company [2991]	$1,047	475%
Oxford Health Plans [2992]	$1,047	475%
Zzumr-Salt Lake City Ut [3169]	$1,047	475%

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 $288.
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 Hillcrest 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.