CMS Price Transparency Data

Neurobehavioral status check

Facility: Springfield Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $304
Cash Discount Price: $286
vs. Medicare Baseline: 1.38x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Springfield Hospital is $304. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $286. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.38x the Medicare baseline. Located in Po Box 2003, Springfield, VT.

Cash / Self-Pay

$286

Average discount available for prompt cash payment at this facility.

Insurance Median

$304

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: $286 (130%)

Insurance Median: $304 (138%)

Cash: $286 (130% of Medicare)

Ins. Median: $304 (138% 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
Blue Cross Blue Shield	$145 - $381	66%
Mvp Health Plan	$145 - $293	66%
UnitedHealthcare	$145 - $343	66%
Wellsense	$145 - $381	66%
Harvard Pilgrim Health Care	$146 - $315	66%
Wellcare	$149	68%
Tufts Health Plan	$234	106%
Cigna	$267 - $396	121%
Multiplan	$316	143%
Aetna	$362	164%
Coventry	$362	164%
Beacon Health	$381	173%
Manage Behavioral Health	$381	173%
Martin'S Point Healthcare	$381	173%

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 $286.
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 Springfield 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.