CMS Price Transparency Data

Neurobehavioral status check

Facility: Charleston Area Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $124
Cash Discount Price: $393
vs. Medicare Baseline: 0.56x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Charleston Area Medical Center is $124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $393. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 0.56x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$393

Average discount available for prompt cash payment at this facility.

Insurance Median

$124

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: $393 (178%)

Insurance Median: $124 (56%)

Cash: $393 (178% of Medicare)

Ins. Median: $124 (56% 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
Triwest Va	$53 - $214	24%
Blue Cross Blue Shield	$54 - $437	24%
Choicecare Network	$54 - $469	24%
UnitedHealthcare	$56 - $469	25%
The Health Plan Of West Virginia Inc.	$57 - $465	26%
West Virginia Senior Advantage Inc.	$57 - $232	26%
Aetna	$60 - $469	27%
Unicare Health Plan Of West Virginia Inc.	$60 - $65	27%
City Of Charleston	$71 - $359	32%
Naphcare	$75 - $441	34%
Integrated Medical Solutions	$79 - $430	36%
Caresource	$82 - $479	37%
Optimum Choice Inc.	$87 - $221	39%
Tricare	$131 - $313	59%
Three Rivers Providers Network	$211 - $506	96%
Healthsmart	$214 - $512	97%
Multiplan	$214 - $512	97%
Cigna	$216 - $517	98%

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 $393.
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 Charleston Area 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.