CMS Price Transparency Data

Neurobehavioral status check

Facility: Childrens Hospital of Wisconsin

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $117
Cash Discount Price: $76
vs. Medicare Baseline: 0.53x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Childrens Hospital of Wisconsin is $117. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $76. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.53x the Medicare baseline. Located in 9000 W Wisconsin Ave, Milwaukee, WI.

Cash / Self-Pay

$76

Average discount available for prompt cash payment at this facility.

Insurance Median

$117

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: $76 (34%)

Insurance Median: $117 (53%)

Cash: $76 (34% of Medicare)

Ins. Median: $117 (53% 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
Froedtert Health	$97 - $118	44%
Medical College Of Wisconsin	$97	44%
Network Health Plan	$99	45%
UnitedHealthcare	$102 - $106	46%
Aspirus Health Plan	$104	47%
Common Ground Healthcare Cooperative	$104 - $118	47%
Trilogy Health Solutions	$104 - $118	47%
Wps Health Plan	$105 - $125	48%
Advocate Aurora Healthcare	$107	49%
Blue Cross Blue Shield	$108 - $132	49%
Centivo	$108	49%
Health Partners	$108 - $122	49%
Employer Health Care Alliance Cooperative	$109	49%
Dean Health Plan	$111	50%
Group Health Cooperative Of Eau Claire	$111	50%
Oan Llc	$111	50%
Security Health Plan	$115	52%
Health Payment Systems	$117	53%
Praire States	$118	53%
Quartz Health Insurance	$118	53%
Sheboygan Employer'S Health Network	$118	53%
Mayo Clinic Health Solutions	$121	55%
Aetna	$122 - $123	55%
Bellin Thedacare	$125	57%
Cigna	$125	57%
Group Health Cooperative Of South Central Wisconsin	$125	57%
Prevea Health Network	$125	57%
Multiplan	$126 - $132	57%
Coventry Health Care	$132	60%

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 $76.
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 Childrens Hospital of Wisconsin 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.