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Pennsylvania rates for HCPCS 96116

Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour

Facilitymedian $91 · 10th–90th $78–$2950%20%10th90th$91Professionalmedian $89 · 10th–90th $71–$1700%10%20%10th90th$89$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $91.20 / $295.12
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $89.13 / $169.82
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $85.11 / $107.15
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $97.72 / $107.15
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $95.50 / $169.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $309.03 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $97.72 / $147.91
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $89.13 / $134.90
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $91.20
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $102.33 / $194.98
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $100.00 / $144.54
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $97.72 / $107.15
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $89.13 / $194.98
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $93.33 / $165.96
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $100.00 / $120.23
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $102.33 / $138.04
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $79.43 / $114.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $102.33 / $162.18