CMS Price Transparency Data

Neurobehavioral status check

Facility: North Central Health Care

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $340
Cash Discount Price: $571
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at North Central Health Care is $340. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $571. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.54x the Medicare baseline. Located in 1150 Lakeview Dr, Wausau, WI.

Cash / Self-Pay

$571

Average discount available for prompt cash payment at this facility.

Insurance Median

$340

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: $571 (259%)

Insurance Median: $340 (154%)

Cash: $571 (259% of Medicare)

Ins. Median: $340 (154% 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
Medicaid / KanCare	$218	99%
Medicare (plans)	$336	152%
Magellan Healthcare Inc	$340	154%
Medica Claims	$340	154%
Security Administrative Services	$340	154%
Group Health Cooperative	$357	162%
Security Health Plan - HMO	$373	169%

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 $571.
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 North Central Health Care 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.