CMS Price Transparency Data

Prosthetic fitting and training

Facility: Baylor Scott and White Medical Center Lake Pointe

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $116
Cash Discount Price: $108
vs. Medicare Baseline: 2.87x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Baylor Scott and White Medical Center Lake Pointe is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $108. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.87x the Medicare baseline. Located in 6800 Scenic Dr, Rowlett, TX.

Cash / Self-Pay

$108

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$40.41

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $40.41 (100%)

Cash / Self-Pay: $108 (267%)

Insurance Median: $116 (287%)

Cash: $108 (267% of Medicare)

Ins. Median: $116 (287% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $40.41 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 287% of the Medicare baseline (a markup of 187%). 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	$20	49%
Wellpoint (Fka Amerigroup)	$20	49%
Baylor Scott & White Health Plan	$89 - $105	220%
Blue Cross Blue Shield	$92 - $196	228%
Aetna	$99	245%
Employers Health Network	$99	245%
Quiktrip	$99	245%
UnitedHealthcare	$104 - $115	257%
University Of Mary Hardin-Baylor	$105	260%
Texas A&M Commerce	$108	267%
Imagine Health	$113	280%
Ambetter / Centene	$117	290%
Curative	$117	290%
First Health	$126	312%
Healthsmart	$126 - $135	312%
Humana	$126	312%
Cigna	$128 - $151	317%
Private Health Care System	$135	334%
Triwest	$135	334%

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 $108.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97761.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Baylor Scott and White Medical Center Lake Pointe is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97761.
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.