CMS Price Transparency Data

Neurobehavioral status check

Facility: Baylor Scott & White Medical Center Pflugerville

Billing Code: 96116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96116
Insurance Median: $421
Cash Discount Price: $459
vs. Medicare Baseline: 1.91x Medicare

The contracted insurance negotiated median rate for a Neurobehavioral status check at Baylor Scott & White Medical Center Pflugerville is $421. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $459. Compared to the federal Medicare reimbursement reference rate of $220.6, this hospital’s rate is 1.91x the Medicare baseline. Located in 2600 East Pflugerville Parkway, Pflugerville, TX.

Cash / Self-Pay

$459

Average discount available for prompt cash payment at this facility.

Insurance Median

$421

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: $459 (208%)

Insurance Median: $421 (191%)

Cash: $459 (208% of Medicare)

Ins. Median: $421 (191% 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.

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	$138 - $281	63%
Baylor Scott & White Health Plan	$267 - $463	121%
Humana	$281 - $536	127%
Triwest	$281	127%
Corvel	$294	133%
Prime Health Services	$294	133%
American Health Plan	$295	134%
Healthspring	$295	134%
Procare Advantage	$295	134%
UnitedHealthcare	$323 - $529	146%
Blue Cross Blue Shield	$352 - $429	160%
Cigna	$364 - $424	165%
Sedgwick	$420	190%
Aetna	$421	191%
Midcoast	$421	191%
Quiktrip	$421	191%
University Of Mary Hardin-Baylor	$444	201%
Independent Medical System	$459	208%
Curative	$498	226%
First Health	$536	243%
Healthsmart	$536 - $574	243%
Private Health Care System	$574	260%
Three Rivers	$689	312%

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 $459.
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 Pflugerville 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.