CMS Price Transparency Data

Neurobehavioral status check

Facility: Mon Health Medical Center

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $1,886
Cash Discount Price: $1,179
vs. Medicare Baseline: 8.55x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Mon Health Medical Center is $1,886. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,179. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 8.55x the Medicare baseline. Located in 1200 Jd Anderson Drive, Morgantown, WV.

Cash / Self-Pay

$1,179

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,886

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: $1,179 (534%)

Insurance Median: $1,886 (855%)

Cash: $1,179 (534% of Medicare)

Ins. Median: $1,886 (855% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 855% of the Medicare baseline (a markup of 755%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Zelis_Other_Plan	$178	81%
Aetna	$209 - $1,886	95%
Blue Cross Blue Shield	$209 - $1,458	95%
Health_South_Mountain_View_Plan	$209	95%
Humana	$209 - $2,122	95%
Medicare (plans)	$209	95%
Paramount_Elite_Plan	$209	95%
Uhc_Va_Plan	$209	95%
Zelis_Group_Health_Plan	$209	95%
The_Health_Plan_Peia_Plan	$262	119%
Seven_Corners_Plan	$418	189%
Maryland_Physicians_Care_Plan	$1,650	748%
The_Health_Plan_Murray_Energy_Commercial_Aso_Plan	$1,886	855%
The_Health_Plan_Plan	$2,027	919%
Acpn_Plan	$2,122	962%
Cigna	$2,122	962%
Mon_County_Commission_Plan	$2,122	962%
Uhc_Plan	$2,122	962%
Health_Payors_Organization_Plan	$2,169	983%
Uhc_Options_Ppo_Plan	$2,192	994%
Multiplan_Phcs_Plan	$2,239	1015%
Mutual_Of_Omaha_Plan	$2,239	1015%
Geha_Plan	$2,287	1037%
Three_Rivers_Plan	$2,287	1037%
Uhc_Onenet_Ppo_Plan	$2,287	1037%
Upmc__Plan	$2,287	1037%

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 $1,179.
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 Mon Health 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.