CMS Price Transparency Data

Neurobehavioral status check

Facility: Baylor Scott & White Medical Center - Marble Falls

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $443
Cash Discount Price: $483
vs. Medicare Baseline: 2.01x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Baylor Scott & White Medical Center - Marble Falls is $443. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $483. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 2.01x the Medicare baseline. Located in 810 W Highway 71, Marble Falls, TX.

Cash / Self-Pay

$483

Average discount available for prompt cash payment at this facility.

Insurance Median

$443

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: $483 (219%)

Insurance Median: $443 (201%)

Cash: $483 (219% of Medicare)

Ins. Median: $443 (201% 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 201% of the Medicare baseline (a markup of 101%). 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
Superior Health Plan	$145 - $277	66%
Baylor Scott & White Health Plan	$263 - $457	119%
Humana	$277 - $564	126%
Triwest	$277	126%
Corvel	$290	131%
Prime Health Services	$290	131%
American Health Plan	$291	132%
Blue Cross Blue Shield	$291 - $451	132%
Healthspring	$291	132%
Procare Advantage	$291	132%
UnitedHealthcare	$318 - $445	144%
Cigna	$414 - $486	188%
Sedgwick	$414	188%
Aetna	$443	201%
Midcoast	$443	201%
Quiktrip	$443	201%
University Of Mary Hardin-Baylor	$467	212%
Independent Medical System	$483	219%
Curative	$524	238%
First Health	$564	256%
Healthsmart	$564 - $604	256%
Bluebell Creameries	$604	274%
Private Health Care System	$604	274%
Three Rivers	$725	329%

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 $483.
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 Baylor Scott & White Medical Center - Marble Falls 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.