CMS Price Transparency Data

Neurobehavioral status check

Facility: St Marys Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $137
Cash Discount Price: $148
vs. Medicare Baseline: 0.62x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at St Marys Medical Center is $137. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $148. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.62x the Medicare baseline. Located in 2900 1St Avenue, Huntington, WV.

Cash / Self-Pay

$148

Average discount available for prompt cash payment at this facility.

Insurance Median

$137

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: $148 (67%)

Insurance Median: $137 (62%)

Cash: $148 (67% of Medicare)

Ins. Median: $137 (62% 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
The Healthplan	$57 - $62	26%
Unicare	$57 - $62	26%
Aetna	$79 - $311	36%
Blue Cross Blue Shield	$79 - $2,176	36%
Humana	$79 - $311	36%
Peak Health	$79 - $285	36%
Peia	$79 - $346	36%
UnitedHealthcare	$79 - $311	36%
Caresource	$86 - $140	39%
Cigna	$135	61%
Firsthealth	$140	63%
Healthsmart	$140	63%
Phcs Multiplan	$140	63%
Zelis Network	$140	63%
Medicare (plans)	$311	141%

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 $148.
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 St Marys Medical Center 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.