CMS Price Transparency Data

Neurobehavioral status check

Facility: University of Wi Hospitals & Clinics Authority

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $133
Cash Discount Price: $101
vs. Medicare Baseline: 0.60x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at University of Wi Hospitals & Clinics Authority is $133. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $101. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.60x the Medicare baseline. Located in 600 Highland Avenue, Madison, WI.

Cash / Self-Pay

$101

Average discount available for prompt cash payment at this facility.

Insurance Median

$133

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: $101 (46%)

Insurance Median: $133 (60%)

Cash: $101 (46% of Medicare)

Ins. Median: $133 (60% 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	$69 - $221	31%
Alliance_Premier_Network	$81	37%
Mercycare	$84	38%
Triology	$86 - $103	39%
Security_Health_Plan	$91 - $107	41%
Employer'S_Coalition_On_Health	$93 - $130	42%
Alliance	$95	43%
Hfn	$96 - $130	44%
United_Healthcare	$97 - $143	44%
Beloit_Health_System	$98	44%
Aspirus_Health_Plan	$99	45%
Cigna	$101	46%
Health_Partners_Insurance	$103	47%
Health_Payment_Systems	$104	47%
UnitedHealthcare	$106 - $221	48%
Dean_Health_Plan	$108	49%
Medical_Associates	$112	51%
Wps	$117 - $129	53%
Employers_Healthcare_Coalition_Of_Wi	$118	53%
Aetna	$120 - $221	54%
Aspirus_Network_Inc	$130	59%
Chorus_Community	$135	61%
Ghc_Eau_Claire_Health_Plan	$135	61%
Multiplan	$135 - $155	61%
Sheybogan_Employers_Health_Network	$135	61%
Coventry	$144	65%
Dean_Care	$144	65%
Healthsmart	$149	68%
Humana	$221	100%
Medicare (plans)	$221 - $225	100%

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 $101.
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 University of Wi Hospitals & Clinics Authority 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.