Exam of neurobehavioral status, first hour
Medicare pricing data for 4,348 providers across 52 states
Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Exam of neurobehavioral status, first hour (HCPCS code 96116) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $89.89, but hospitals typically charge $255.88 — a 2.8x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $89.89, your out-of-pocket cost would be approximately $17.98. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 2.8x more than what Medicare allows for this procedure. Medicare actually pays $68.88 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Alaska | $123 | $468 | 8 | 205 | +37.4% |
| New York | $98 | $303 | 358 | 10,113 | +9.2% |
| New Jersey | $97 | $228 | 195 | 4,834 | +8.3% |
| Maryland | $97 | $256 | 103 | 3,599 | +7.5% |
| District of Columbia | $95 | $245 | 22 | 575 | +6.2% |
| Hawaii | $93 | $210 | 6 | 111 | +2.9% |
| California | $92 | $223 | 595 | 25,169 | +2.8% |
| Massachusetts | $92 | $298 | 122 | 2,601 | +2.5% |
| Delaware | $92 | $192 | 12 | 371 | +2.3% |
| Florida | $91 | $242 | 335 | 11,588 | +1.4% |
| Connecticut | $91 | $254 | 49 | 892 | +1.0% |
| Illinois | $90 | $330 | 156 | 5,315 | +0.6% |
| Wyoming | $90 | $327 | 3 | 171 | +0.3% |
| New Hampshire | $90 | $166 | 22 | 770 | +0.0% |
| Puerto Rico | $90 | $92 | 14 | 155 | -0.3% |
| Oregon | $89 | $202 | 36 | 1,214 | -0.5% |
| Nevada | $89 | $183 | 22 | 1,816 | -0.5% |
| Arizona | $89 | $209 | 118 | 4,242 | -0.9% |
| Georgia | $89 | $234 | 88 | 2,334 | -1.2% |
| Rhode Island | $89 | $196 | 21 | 208 | -1.3% |
| Washington | $89 | $278 | 65 | 1,459 | -1.3% |
| Texas | $89 | $252 | 317 | 9,024 | -1.4% |
| Virginia | $88 | $247 | 104 | 3,360 | -2.0% |
| Pennsylvania | $88 | $238 | 167 | 3,332 | -2.4% |
| Oklahoma | $88 | $183 | 24 | 471 | -2.4% |
| Minnesota | $88 | $368 | 72 | 1,895 | -2.4% |
| Colorado | $87 | $336 | 80 | 1,947 | -2.7% |
| Michigan | $87 | $208 | 223 | 5,604 | -2.8% |
| South Carolina | $87 | $233 | 21 | 578 | -3.5% |
| Missouri | $86 | $255 | 50 | 2,714 | -3.8% |
| Vermont | $86 | $322 | 10 | 587 | -4.0% |
| Nebraska | $86 | $257 | 18 | 702 | -4.1% |
| Utah | $85 | $202 | 25 | 693 | -5.0% |
| Kentucky | $85 | $292 | 45 | 1,243 | -5.0% |
| Indiana | $85 | $288 | 61 | 1,752 | -5.1% |
| South Dakota | $85 | $128 | 7 | 162 | -5.2% |
| Mississippi | $85 | $277 | 13 | 680 | -5.2% |
| Kansas | $85 | $350 | 15 | 1,006 | -5.8% |
| Montana | $85 | $191 | 20 | 516 | -5.8% |
| North Carolina | $84 | $239 | 90 | 3,370 | -6.0% |
| West Virginia | $84 | $269 | 21 | 453 | -6.6% |
| Ohio | $84 | $304 | 155 | 3,480 | -6.8% |
| Maine | $84 | $311 | 25 | 377 | -6.8% |
| New Mexico | $84 | $220 | 37 | 798 | -6.9% |
| Louisiana | $83 | $216 | 40 | 750 | -7.3% |
| Wisconsin | $83 | $555 | 103 | 2,934 | -7.6% |
| Arkansas | $83 | $218 | 22 | 862 | -7.9% |
| Tennessee | $81 | $255 | 64 | 1,931 | -9.5% |
| Iowa | $81 | $239 | 36 | 1,582 | -9.7% |
| Idaho | $81 | $190 | 12 | 181 | -9.8% |
| Alabama | $80 | $156 | 105 | 1,824 | -11.1% |
| North Dakota | $78 | $112 | 12 | 848 | -12.8% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber