CMS Price Transparency Data

Neurobehavioral status check

Facility: Fort Memorial Hospital

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $290
Cash Discount Price: $139
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Fort Memorial Hospital is $290. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $139. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.31x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$139

Average discount available for prompt cash payment at this facility.

Insurance Median

$290

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: $139 (63%)

Insurance Median: $290 (131%)

Cash: $139 (63% of Medicare)

Ins. Median: $290 (131% 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
Molina	$81 - $300	37%
Aetna	$115 - $430	52%
UnitedHealthcare	$142 - $435	64%
Group Health Cooperative	$185 - $491	84%
Dean Health Plan	$187 - $376	85%
Alliance	$205 - $412	93%
Mercycare	$213 - $427	97%
Blue Cross Blue Shield	$241 - $300	109%
Trilogy	$251 - $505	114%
Fort Care	$252	114%
Medicaid / KanCare	$254	115%
Quartz	$254 - $406	115%
Cigna	$272 - $545	123%
Managed Health Services	$277	126%
Centivo	$288 - $300	131%
Humana	$300 - $409	136%
Medicare (plans)	$300	136%
Veteran Evaluation Services	$363	165%

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 $139.
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 Fort Memorial 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.