CMS Price Transparency Data

Neurobehavioral status check

Facility: Cook Childrens Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $781
Cash Discount Price: $1,331
vs. Medicare Baseline: 3.54x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Cook Childrens Medical Center is $781. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,331. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 3.54x the Medicare baseline. Located in 801 Seventh Avenue, Fort Worth, TX.

Cash / Self-Pay

$1,331

Average discount available for prompt cash payment at this facility.

Insurance Median

$781

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: $1,331 (603%)

Insurance Median: $781 (354%)

Cash: $1,331 (603% of Medicare)

Ins. Median: $781 (354% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 354% of the Medicare baseline (a markup of 254%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Health Plan W. Uhrip	$70 - $675	32%
Health Plan W/O Uhrip	$70 - $594	32%
Aetna	$100 - $1,509	45%
Beacon	$426 - $781	193%
Firstcare	$426 - $1,420	193%
Rightcare	$594 - $781	269%
United Community	$623 - $624	282%
Wellpoint	$623 - $624	282%
Blue Cross Blue Shield	$641 - $1,598	291%
Molina	$657	298%
El Paso Health First	$781	354%
Superior Health	$781	354%
Tx Children Health	$781	354%
UnitedHealthcare	$781 - $1,509	354%
S&W Health	$1,491	676%
Cigna	$1,508 - $1,509	684%
Healthscope	$1,508 - $1,509	684%
Imagine Health	$1,508 - $1,509	684%
Humana	$1,544 - $1,562	700%
Multiplan	$1,544	700%
First Health	$1,562	708%
Galaxy Health	$1,597 - $1,598	724%
Healthsmart	$1,597 - $1,598	724%
Usamco	$1,633	740%

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 $1,331.
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 Cook Childrens Medical Center 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.