CMS Price Transparency Data

Prosthetic fitting and training

Facility: Baylor Scott & White Medical Center Pflugerville

Billing Code: 97761 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97761
Insurance Median: $119
Cash Discount Price: $105
vs. Medicare Baseline: 2.94x Medicare

The contracted insurance negotiated median rate for a Prosthetic fitting and training at Baylor Scott & White Medical Center Pflugerville is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $40.41, this hospital’s rate is 2.94x the Medicare baseline. Located in 2600 East Pflugerville Parkway, Pflugerville, TX.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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: $105 (260%)

Insurance Median: $119 (294%)

Cash: $105 (260% of Medicare)

Ins. Median: $119 (294% 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 294% of the Medicare baseline (a markup of 194%). 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	$31	77%
Baylor Scott & White Health Plan	$63 - $75	156%
Aetna	$96	238%
Midcoast	$96	238%
Quiktrip	$96	238%
University Of Mary Hardin-Baylor	$101	250%
Independent Medical System	$105	260%
UnitedHealthcare	$109	270%
Curative	$113	280%
Humana	$113 - $122	280%
Blue Cross Blue Shield	$119 - $145	294%
First Health	$122	302%
Healthsmart	$122 - $131	302%
Private Health Care System	$131	324%
Triwest	$131	324%
Cigna	$149 - $185	369%
Three Rivers	$157	389%

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 $105.
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 & White Medical Center Pflugerville 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.