CMS Price Transparency Data

Neurobehavioral status check

Facility: Forks Community Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $73
Cash Discount Price: $65
vs. Medicare Baseline: 0.33x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Forks Community Hospital is $73. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $65. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.33x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$65

Average discount available for prompt cash payment at this facility.

Insurance Median

$73

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: $65 (29%)

Insurance Median: $73 (33%)

Cash: $65 (29% of Medicare)

Ins. Median: $73 (33% 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
Coordinated Care (Mco) Mcd-All Plans	$45	20%
Medicaid / KanCare	$45 - $48	20%
UnitedHealthcare	$45 - $101	20%
Cigna	$65	29%
Humana	$73	33%
Molina Commercial-All Other Plans	$73	33%
Triwest-All Plans	$73	33%
Va-Ihs - All Plans	$73	33%
Tricare	$74	34%
Aetna	$77	35%
Regence-All Other Plans	$81	37%
Community Health Network Mcr-All Other Plans	$84	38%
Medicare (plans)	$84	38%
Ambetter / Centene	$85	39%
Wellcare Med Adv - All Plans	$85	39%
Community Health Exchange	$98	44%
Blue Cross Blue Shield	$112	51%
First Choice-All Plans	$114	52%

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 $65.
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 Forks Community 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.