CMS Price Transparency Data

Neurobehavioral status check

Facility: Uva Health Culpeper Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $131
Cash Discount Price: $88
vs. Medicare Baseline: 0.59x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Uva Health Culpeper Medical Center is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $88. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.59x the Medicare baseline. Located in 501 Sunset Lane, Culpeper, VA.

Cash / Self-Pay

$88

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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: $88 (40%)

Insurance Median: $131 (59%)

Cash: $88 (40% of Medicare)

Ins. Median: $131 (59% 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
Cigna	$68 - $118	31%
Champva [50002]	$80	36%
Tricare	$80	36%
Aetna	$83 - $155	38%
Beacon Health Options [40012]	$88	40%
Commercial Contracted Hb Only [40056]	$92	42%
Commercial Generic [40000]	$92 - $123	42%
Geha [40009]	$102 - $292	46%
UnitedHealthcare	$102 - $360	46%
Commercial Contracted Tpa [40055]	$106 - $123	48%
Umwa [40037]	$123	56%
Healthsmart [40013]	$132	60%
Multiplan Generic [40035]	$134 - $150	61%
Vhn Generic [40040]	$134 - $150	61%
Sentara Behavioral Health [40052]	$137 - $403	62%
Sentara [40021]	$137 - $403	62%
First Health Generic [40033]	$144	65%
Gateway Health Alliance [40034]	$150	68%
Onenet Workers Comp Generic [60010]	$154	70%
Kaiser Permenente [40014]	$158	72%
Carefirst [30007]	$192 - $240	87%

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 $88.
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 Uva Health Culpeper 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.