MEDICAL CITY MENTAL HEALTH AND WELLNESS CENTER - ALLIANCE
3100 Alliance Town Ctr, FORT WORTH, TX · Medicalcityhealthcare · · NPI 1316775935
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 |
|---|---|---|---|---|
| 11-desoxycortisol - sendout CPT 82634 | not published | not published | $29.28 – $76.71 | 6 |
| 17-hydroxypregnenolone CPT 84143 | not published | not published | $22.81 – $59.76 | 6 |
| 17-ketosteroids CPT 83586 | not published | not published | $12.80 – $33.54 | 6 |
| 1pc ost pch drain hgh output HCPCS A4435 | not published | not published | $8.21 – $21.51 | 6 |
| 1 pc ost pouch w filter HCPCS A5056 | not published | not published | $6.66 – $17.45 | 6 |
| 1 pc ost pou w built-in conv HCPCS A5057 | not published | not published | $13.68 – $35.84 | 6 |
| 2019-ncov diagnostic p HCPCS U0001 | not published | not published | $35.92 – $94.11 | 6 |
| 3-d radiotherapy plan CPT 77295 | not published | not published | $440.17 – $440.17 | 1 |
| 3d recon without postprocess indpndt CPT 76376 | not published | not published | $584.00 – $584.00 | 1 |
| 4-bar link above knee w/swng HCPCS L5614 | not published | not published | $2,088.90 – $5,472.92 | 6 |
| 5' nucleotidase - sendout CPT 83915 | not published | not published | $11.15 – $29.21 | 6 |
| 88334 ap bill cytologic exam each additional site CPT 88334 | not published | not published | $25.29 – $25.29 | 1 |
| #a/b/c/c/h pnl-candida albicans ab CPT 86628 | not published | not published | $12.01 – $31.47 | 6 |
| Abd aorta w/runoff s&i CPT 75630 | not published | not published | $109.62 – $109.62 | 1 |
| Abdominal CT scan (with and without contrast) CPT 74170 | not published | not published | $584.00 – $584.00 | 1 |
| Abdominal CT scan (with contrast) CPT 74160 | not published | not published | $584.00 – $584.00 | 1 |
| Abdominal CT scan (without contrast) CPT 74150 | not published | not published | $584.00 – $584.00 | 1 |
| Abdominal MRI (with and without contrast) CPT 74183 | not published | not published | $761.00 – $761.00 | 1 |
| Abdominal MRI (with contrast) CPT 74182 | not published | not published | $761.00 – $761.00 | 1 |
| Abdominal MRI (without contrast) CPT 74181 | not published | not published | $761.00 – $761.00 | 1 |
| Abdominal pad HCPCS L1270 | not published | not published | $90.43 – $236.93 | 6 |
| Abdominal Ultrasound (complete) CPT 76700 | $1,592.02 | $1,592.02 | $134.43 – $134.43 | 1 |
| Abdominal Ultrasound (limited) CPT 76705 | $1,373.14 | $1,373.14 | $101.17 – $101.17 | 1 |
| Abduct control hip semi-flex HCPCS L1630 | not published | not published | $194.72 – $510.17 | 6 |
| Abduction bar jointed adjust HCPCS L2300 | not published | not published | $412.52 – $1,080.80 | 6 |
| Abduction bar-straight HCPCS L2310 | not published | not published | $188.49 – $493.84 | 6 |
| Abduction rotation bar shoe HCPCS L3140 | not published | not published | $110.03 – $288.28 | 6 |
| Abduct rotation bar without shoe HCPCS L3150 | not published | not published | $100.56 – $263.47 | 6 |
| Abl1 gene CPT 81170 | not published | not published | $300.00 – $786.00 | 6 |
| Above elbow prosth tiss shap HCPCS L6500 | not published | not published | $3,808.49 – $9,978.24 | 6 |
| Above knee cushion socket HCPCS L5648 | not published | not published | $949.75 – $2,488.35 | 6 |
| Above knee flex cover system HCPCS L5964 | not published | not published | $1,146.54 – $3,003.93 | 6 |
| Above knee hydracadence HCPCS L5610 | not published | not published | $2,937.63 – $7,696.59 | 6 |
| Above knee leather socket HCPCS L5642 | not published | not published | $782.30 – $2,049.63 | 6 |
| Above knee manual lock HCPCS L5925 | not published | not published | $548.48 – $1,437.02 | 6 |
| Above knee wood socket HCPCS L5644 | not published | not published | $862.59 – $2,259.99 | 6 |
| Absorpt drg >16<=48 in w/bdr HCPCS A6255 | not published | not published | $4.34 – $11.37 | 6 |
| Absorpt drg >16 <=48 without bdr HCPCS A6252 | not published | not published | $4.64 – $12.16 | 6 |
| Absorpt drg <=16 sq in w/bdr HCPCS A6254 | not published | not published | $1.70 – $4.45 | 6 |
| Absorpt drg <=16 sq in without b HCPCS A6251 | not published | not published | $2.84 – $7.44 | 6 |
| Absorpt drg > 48 sq in without b HCPCS A6253 | not published | not published | $9.03 – $23.66 | 6 |
| Acetaminophen level CPT 80143 | not published | not published | $18.64 – $48.84 | 6 |
| Acetone qualitative CPT 82009 | not published | not published | $4.52 – $11.84 | 6 |
| Acetylcholine receptor modulating antibody CPT 86043 | not published | not published | $12.05 – $31.57 | 6 |
| Acetylcholinesterase assay CPT 82013 | not published | not published | $12.29 – $32.20 | 6 |
| Aco annual medicare visit (awv), initial g0438aco HCPCS G0438 | not published | not published | $173.26 – $453.94 | 6 |
| Aco annual medicare visit (awv), subsq g0439aco HCPCS G0439 | not published | not published | $136.66 – $358.05 | 6 |
| Aco med nutria tx/group, ea 30 min 97804aco CPT 97804 | not published | not published | $14.41 – $37.75 | 6 |
| Acth stimulation panel CPT 80402 | not published | not published | $86.96 – $227.84 | 6 |
| Acth stimulation panel CPT 80406 | not published | not published | $78.26 – $205.04 | 6 |
| Acute hepatitis panel CPT 80074 | $584.22 | $584.22 | $47.63 – $124.79 | 6 |
| Acute venous thrombus image CPT 78456 | not published | not published | $421.35 – $421.35 | 1 |
| #acylcarnitineprfl CPT 82017 | not published | not published | $16.87 – $44.20 | 6 |
| Acylcarnitines qual CPT 82016 | not published | not published | $16.49 – $43.20 | 6 |
| Additional switch, ext power HCPCS L6611 | not published | not published | $509.68 – $1,335.36 | 6 |
| Add le poly knee custom kafo HCPCS L2387 | not published | not published | $190.18 – $498.27 | 6 |
| Add ue prost a/e acrylic HCPCS L7404 | not published | not published | $688.03 – $1,802.64 | 6 |
| Add ue prost a/e ultlite mat HCPCS L7401 | not published | not published | $424.75 – $1,112.85 | 6 |
| Add ue prost b/e acrylic HCPCS L7403 | not published | not published | $455.88 – $1,194.41 | 6 |
| Add ue prost be/wd, ultlite HCPCS L7400 | not published | not published | $379.41 – $994.05 | 6 |
| Add ue prost s/d acrylic HCPCS L7405 | not published | not published | $899.88 – $2,357.69 | 6 |
| Add ue prost s/d ultlite mat HCPCS L7402 | not published | not published | $458.68 – $1,201.74 | 6 |
| Add up-ex prosthes lock mech HCPCS L6698 | not published | not published | $703.88 – $1,844.17 | 6 |
| Adenovirus ag ia CPT 87301 | not published | not published | $11.98 – $31.39 | 6 |
| Adenovirus antibody,serum - quest CPT 86603 | not published | not published | $12.87 – $33.72 | 6 |
| Adenovirus assay w/optic CPT 87809 | not published | not published | $21.76 – $57.01 | 6 |
| Adhesive, liquid or equal HCPCS A4364 | not published | not published | $3.86 – $10.11 | 6 |
| Adh-sendout CPT 84588 | not published | not published | $33.94 – $88.92 | 6 |
| Adrenal cortex & medulla img CPT 78075 | not published | not published | $649.06 – $649.06 | 1 |
| Advance care planning each additional 30 min 99498 CPT 99498 | not published | not published | $77.79 – $203.81 | 6 |
| _afb id by dna probe rflx ast CPT 87149 | not published | not published | $20.05 – $52.53 | 6 |
| #afb mycobacteria suscep. #1 CPT 87190 | not published | not published | $7.31 – $19.15 | 6 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | not published | not published | $115.36 – $302.24 | 6 |
| Aff2 gen aly detc abnl allel CPT 81171 | not published | not published | $137.00 – $358.94 | 6 |
| Aff2 gen alys charac alleles CPT 81172 | not published | not published | $274.83 – $720.05 | 6 |
| Afo molded ankle gauntlet HCPCS L1904 | not published | not published | $540.36 – $1,415.74 | 6 |
| Afo molded plas rig ant tib HCPCS L1945 | not published | not published | $1,063.73 – $2,786.97 | 6 |
| Afo molded to patient plasti HCPCS L1940 | not published | not published | $581.88 – $1,524.53 | 6 |
| Afo rig ant tib tcf/= custom HCPCS L1932 | not published | not published | $1,102.55 – $2,888.68 | 6 |
| Afo sing bar clasp attach sh HCPCS L1910 | not published | not published | $346.21 – $907.07 | 6 |
| Afo sing solid stirrup calf HCPCS L1980 | not published | not published | $440.87 – $1,155.08 | 6 |
| Afo sing upright with adjust s HCPCS L1920 | not published | not published | $415.96 – $1,089.82 | 6 |
| Afo spiral molded to pt plas HCPCS L1950 | not published | not published | $858.83 – $2,250.13 | 6 |
| Afo sprng wir drsflx calf bd HCPCS L1900 | not published | not published | $398.09 – $1,043.00 | 6 |
| Afo supramalleolar custom HCPCS L1907 | not published | not published | $695.21 – $1,821.45 | 6 |
| Afo tib fx cast molded to pt HCPCS L2108 | not published | not published | $1,335.93 – $3,500.14 | 6 |
| Afo tib fx cast plaster mold HCPCS L2106 | not published | not published | $961.61 – $2,519.42 | 6 |
| Afo tib fx semi-rigid l2114 HCPCS L2114 | not published | not published | $753.46 – $1,974.07 | 6 |
| Afo tibial fracture rigid HCPCS L2116 | not published | not published | $902.69 – $2,365.05 | 6 |
| Afo tibial fracture soft HCPCS L2112 | not published | not published | $650.87 – $1,705.28 | 6 |
| Afo, walk boot type, cus fab HCPCS L4631 | not published | not published | $1,827.50 – $4,788.05 | 6 |
| Afo w/ankle joint, prefab HCPCS L1971 | not published | not published | $579.11 – $1,517.27 | 6 |
| Ak 4 bar ling w/hydraul swig HCPCS L5613 | not published | not published | $3,038.19 – $7,960.06 | 6 |
| Ak 4 bar link w/fric swing HCPCS L5611 | not published | not published | $1,972.47 – $5,167.87 | 6 |
| Ak/bk self-aligning unit ea HCPCS L5617 | not published | not published | $692.60 – $1,814.61 | 6 |
| Ak flex inner socket ext fra HCPCS L5651 | not published | not published | $1,960.29 – $5,135.96 | 6 |
| Ak/knee disartic acrylic soc HCPCS L5631 | not published | not published | $717.21 – $1,879.09 | 6 |
| Ak/knee disartic pelvic band HCPCS L5697 | not published | not published | $98.28 – $257.49 | 6 |
| Ak/knee disartic pelvic join HCPCS L5696 | not published | not published | $271.74 – $711.96 | 6 |
| Ak/knee disartic silesian ba HCPCS L5698 | not published | not published | $146.51 – $383.86 | 6 |
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.