Neurobehavioral status check
Facility: Wamego Health Center
Billing Code: 96116 (CPT)
- CPT Billing Code: 96116
- Insurance Median: $93
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.42x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $89 | 40% |
| Medicaid / KanCare | $93 | 42% |
| Aetna | $93 | 42% |
| Providrs Care | $116 | 53% |
| Tricare | $177 | 80% |
Consumer Guidance & Cost Commentary
For the CPT code 96116, "Neurobehavioral status check," the facility in Wamego, KS, has a median negotiated rate of $93.00 across five payers, including UnitedHealthcare, Medicaid/KanCare, Aetna, Providrs Care, and Tricare. While the data does not provide a specific cash or self-pay price, patients should be aware that cash payments can sometimes result in lower out-of-pocket costs if the insurance negotiated rate exceeds the cash price, particularly for those with high-deductible plans. It is crucial to contact the facility directly to inquire about "self-pay" or "prompt-pay" discounts, which can range from 20% to 50% off the billed amount when paid in full upfront, bypassing the administrative costs associated with insurance billing cycles.
This service is provided by a Critical Access Hospital, and while the data does not list specific county or state average comparisons for this exact procedure, the facility's negotiated rates are anchored by the Medicare amount of $220.60. Under the No Surprises Act, patients are protected from balance billing for out-of-network providers at in-network facilities, meaning they should not face unexpected bills for the difference between a provider's full chargemaster rate and their insurance allowed amount. If a patient receives an itemized bill that appears inflated or contains unbundled codes, they should request a formal itemized audit to identify errors, as over 80% of hospital bills contain discrepancies that can be resolved through written dispute with the billing supervisor.