CMS Price Transparency Data

Prostate cancer screening (blood test)

Facility: Baylor Scott & White Medical Center Pflugerville

Billing Code: G0103 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0103
Insurance Median: $109
Cash Discount Price: $142
vs. Medicare Baseline: 5.64x Medicare

The contracted insurance negotiated median rate for a Prostate cancer screening (blood test) at Baylor Scott & White Medical Center Pflugerville is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $142. Compared to the federal Medicare reimbursement reference rate of $19.31, this hospital’s rate is 5.64x the Medicare baseline. Located in 2600 East Pflugerville Parkway, Pflugerville, TX.

Cash / Self-Pay

$142

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$19.31

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $19.31 (100%)

Cash / Self-Pay: $142 (735%)

Insurance Median: $109 (564%)

Cash: $142 (735% of Medicare)

Ins. Median: $109 (564% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $19.31 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 564% of the Medicare baseline (a markup of 464%). 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
UnitedHealthcare	$11 - $22	57%
Baylor Scott & White Health Plan	$18 - $102	93%
Humana	$19 - $166	98%
Superior Health Plan	$19 - $43	98%
Triwest	$19	98%
American Health Plan	$20	104%
Corvel	$20	104%
Healthspring	$20	104%
Prime Health Services	$20	104%
Procare Advantage	$20	104%
Sedgwick	$29	150%
Blue Cross Blue Shield	$94 - $114	487%
Cigna	$113 - $131	585%
Aetna	$131	678%
Midcoast	$131	678%
Quiktrip	$131	678%
University of Mary Hardin-Baylor	$138	715%
Independent Medical System	$142	735%
Curative	$154	798%
First Health	$166	860%
Healthsmart	$166 - $178	860%
Private Health Care System	$178	922%
Three Rivers	$214	1108%

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 $142.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0103.

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 HCPCS code G0103.
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.