Texas Health Arlington Memorial Hospital
800 W Randol Mill Rd, Arlington, TX · Texashealth · · NPI 1174533343
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Lipoprotein direct measurement ldl CPT 83721 | $99.45 | $165.75 | $8.82 – $39.31 | 11 |
| Lipoprtn dir meas sd ldl chl CPT 83722 | not published | not published | $28.72 – $31.02 | 7 |
| Listeria monocytogenes CPT 86723 | not published | not published | $11.08 – $25.90 | 8 |
| Lithium therapeutic drug level CPT 80178 | $147.30 | $245.50 | $5.55 – $27.22 | 11 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | $5,847.75 | $9,746.25 | not published | 0 |
| Liver elastography 91200 CPT 91200 | not published | not published | $31.93 – $35.12 | 8 |
| Liver Function Test CPT 80076 | $370.20 | $617.00 | $6.86 – $34.27 | 11 |
| Liver imaging CPT 78201 | $777.90 | $1,296.50 | $179.10 – $197.01 | 8 |
| Liver imag w/vasclr flow CPT 78202 | $820.20 | $1,367.00 | $195.46 – $215.01 | 8 |
| Liver/spleen imag static only CPT 78215 | $1,069.20 | $1,782.00 | $184.44 – $202.88 | 8 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $1,069.20 | $1,782.00 | $128.64 – $141.50 | 8 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $1,088.27 – $1,197.10 | 8 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $211.50 | $352.50 | $0.87 – $0.87 | 1 |
| Long tongue stirrup HCPCS L2265 | $293.85 | $489.75 | not published | 0 |
| Loop ostmy bridg ster HCPCS A4421 | $27.60 | $46.00 | not published | 0 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $39.61 | $66.01 | $0.48 – $0.48 | 1 |
| Lo sag rig pnl stays pre cst HCPCS L0626 | $156.86 | $261.42 | not published | 0 |
| Low back disk surgery CPT 63030 | not published | not published | $2,398.52 – $2,638.37 | 8 |
| Low cost skin substitute app HCPCS C5271 | $933.60 | $1,556.00 | not published | 0 |
| Low cost skin substitute app HCPCS C5273 | $2,710.80 | $4,518.00 | not published | 0 |
| Low cost skin substitute app HCPCS C5275 | $933.60 | $1,556.00 | not published | 0 |
| Low cost skin substitute app HCPCS C5277 | $2,710.80 | $4,518.00 | not published | 0 |
| Low cost skin substitute app HCPCS C5272 | $466.80 | $778.00 | not published | 0 |
| Low cost skin substitute app HCPCS C5274 | $1,355.40 | $2,259.00 | not published | 0 |
| Low cost skin substitute app HCPCS C5276 | $466.80 | $778.00 | not published | 0 |
| Low cost skin substitute app HCPCS C5278 | $1,355.40 | $2,259.00 | not published | 0 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $3,264.90 | $5,441.50 | $175.06 – $192.57 | 8 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $2,612.85 | $4,354.75 | $173.75 – $191.13 | 8 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $2,394.15 | $3,990.25 | $104.75 – $115.23 | 8 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $3,264.90 | $5,441.50 | $329.13 – $362.04 | 8 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,612.85 | $4,354.75 | $279.00 – $306.90 | 8 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,394.15 | $3,990.25 | $197.14 – $216.85 | 8 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $524.40 | $874.00 | $40.10 – $44.11 | 8 |
| Lower jaw bone graft CPT 21215 | not published | not published | $2,788.09 – $3,066.90 | 8 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $1,888.85 – $2,077.74 | 8 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $3,110.01 – $3,421.01 | 8 |
| Lso flex no ri stays pre ots HCPCS L0628 | $135.35 | $225.58 | not published | 0 |
| Lso r post pnl sj-t9 pre cst HCPCS L0630 | $326.82 | $544.69 | not published | 0 |
| Lso sagit rigid panel prefab HCPCS L0635 | $1,990.83 | $3,318.05 | not published | 0 |
| Lso sc r pos/lat pnl pre cst HCPCS L0633 | $577.00 | $961.66 | not published | 0 |
| Lso sc r pos/lat pnl pre ots HCPCS L0649 | $598.52 | $997.53 | not published | 0 |
| Lso s/c shell/panel custom HCPCS L0640 | $2,320.59 | $3,867.65 | not published | 0 |
| L/s ratio fetal lung CPT 83661 | not published | not published | $18.47 – $43.14 | 8 |
| Lumbar diskogram s&i CPT 72295 | not published | not published | $111.60 – $122.76 | 8 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $7,051.26 – $7,756.39 | 8 |
| Lumizyme injection HCPCS J0221 | $1,909.58 | $3,182.62 | $206.75 – $753.39 | 3 |
| Lung function test (mbc/mvv) CPT 94200 | $241.80 | $403.00 | $74.70 – $74.70 | 1 |
| Lung Function Test (Spirometry) CPT 94010 | $356.85 | $594.75 | $187.88 – $187.88 | 1 |
| Lung perfusion imaging CPT 78580 | $1,257.45 | $2,095.75 | $221.20 – $243.32 | 8 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $16.84 – $39.35 | 8 |
| Lymphatics/lymph node imaging CPT 78195 | $1,654.65 | $2,757.75 | $329.79 – $362.77 | 8 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $30.71 – $110.80 | 8 |
| Lymphocyte transformation mitogen CPT 86353 | $196.80 | $328.00 | $41.19 – $202.68 | 11 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $102.61 – $171.93 | 8 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $39.98 – $93.40 | 8 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $284.65 – $313.12 | 8 |
| Lymph vessel x-ray arms/legs CPT 75803 | not published | not published | $299.60 – $329.56 | 8 |
| Lymph vessel x-ray trunk CPT 75805 | not published | not published | $313.39 – $344.73 | 8 |
| Lymph vessel x-ray trunk CPT 75807 | $5,479.20 | $9,132.00 | $146.54 – $161.19 | 8 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $187.22 – $205.94 | 8 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $1,063.52 – $1,169.87 | 8 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $652.80 – $718.08 | 8 |
| Macro exam dissect molec study ea CPT 88387 | $559.20 | $932.00 | $7.22 – $18.98 | 4 |
| Macroscopic exam arthropod CPT 87168 | not published | not published | $3.59 – $8.37 | 8 |
| Macroscopic exam parasite CPT 87169 | $39.30 | $65.50 | $3.62 – $17.14 | 11 |
| Magnesium CPT 83735 | $160.50 | $267.50 | $5.63 – $27.22 | 11 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $58.70 | $97.83 | $0.09 – $0.09 | 1 |
| Magnetic image bone marrow CPT 77084 | not published | not published | $233.47 – $256.82 | 8 |
| Makena, 10 mg HCPCS J1726 | $1,589.94 | $2,649.90 | $56.97 – $56.97 | 2 |
| Malaria antibody CPT 86750 | not published | not published | $11.08 – $25.90 | 8 |
| Male sling procedure CPT 53440 | not published | not published | $7,582.22 – $8,340.44 | 8 |
| Mammosite ced HCPCS C1728 | $6,600.00 | $11,000.00 | not published | 0 |
| Manipulate finger w/anesth CPT 26340 | not published | not published | $593.04 – $652.34 | 8 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | $593.04 – $652.34 | 8 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $82.50 | $137.50 | $148.06 – $148.06 | 1 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $188.70 | $314.50 | $148.06 – $148.06 | 1 |
| Manipulation of hip joint CPT 27275 | not published | not published | $593.04 – $652.34 | 8 |
| Manipulation of spine CPT 22505 | not published | not published | $593.04 – $652.34 | 8 |
| Manipulat palm cord post inj CPT 26341 | not published | not published | $66.72 – $73.39 | 8 |
| Mannitol 12.5 gm/50 ml inj HCPCS J2150 | $9.00 | $15.00 | $4.01 – $4.01 | 1 |
| Manual diff wbc count b-coat CPT 85009 | not published | not published | $4.26 – $7.29 | 8 |
| Mapping io sentinel lymph node CPT 38900 | not published | not published | not published | 0 |
| Map tachycard site(s) CPT 93609 | $7,396.05 | $12,326.75 | $355.27 – $355.27 | 1 |
| Marker biop eviva buckle ss HCPCS A4648 | $2,880.00 | $4,800.00 | not published | 0 |
| Marker lymphatic sentimag magtrace 10 vial HCPCS A9697 | $2,455.60 | $4,092.66 | $0.47 – $0.47 | 1 |
| Mastectomy partial CPT 19301 | not published | not published | $963.66 – $1,060.03 | 8 |
| Mastoidectomy CPT 69501 | not published | not published | $1,954.22 – $2,149.64 | 8 |
| Mastoidectomy complete 69502 CPT 69502 | not published | not published | $1,954.22 – $2,149.64 | 8 |
| Mastoids complete CPT 70130 | $300.60 | $501.00 | $62.15 – $68.37 | 8 |
| Mastoid surgery revision CPT 69603 | not published | not published | $1,954.22 – $2,149.64 | 8 |
| Mastopexy CPT 19316 | not published | not published | $1,845.21 – $2,029.73 | 8 |
| Mast simple complete CPT 19303 | not published | not published | $1,845.21 – $2,029.73 | 8 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | $184.50 | $307.50 | not published | 0 |
| M.avium-intra dna amp prob CPT 87561 | not published | not published | $29.48 – $68.88 | 8 |
| M.avium-intra dna dir prob CPT 87560 | not published | not published | $22.92 – $39.35 | 8 |
| M.avium-intra dna quant CPT 87562 | not published | not published | $35.99 – $84.07 | 8 |
| Maxillofacial fixation CPT 21100 | not published | not published | $1,954.22 – $2,149.64 | 8 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $25.95 | $43.25 | $12.15 – $59.49 | 11 |
| Mayo aathr protein s free CPT 85306 | $180.30 | $300.50 | $12.87 – $63.54 | 11 |
| Mayo activated protein c resistance assay CPT 85307 | $196.20 | $327.00 | $12.87 – $63.54 | 11 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.