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 |
|---|---|---|---|---|
| Drop lock knee HCPCS L2182 | not published | not published | $131.81 – $345.34 | 6 |
| Drop lock retainer each HCPCS L2785 | not published | not published | $36.42 – $95.42 | 6 |
| Drsg surg adh 11x11 3/4 occl drap wnd 28x30 HCPCS A6259 | not published | not published | $15.59 – $40.85 | 6 |
| Drug assay caffeine CPT 80155 | not published | not published | $38.57 – $101.05 | 6 |
| Drug assay posaconazole CPT 80187 | not published | not published | $27.11 – $71.03 | 6 |
| Drug assay rufinamide CPT 80210 | not published | not published | $27.11 – $71.03 | 6 |
| Drug assay vedolizumab CPT 80280 | not published | not published | $38.57 – $101.05 | 6 |
| Drug assay voriconazole CPT 80285 | not published | not published | $27.11 – $71.03 | 6 |
| Drug asy hydroxychloroquine CPT 80220 | not published | not published | $18.64 – $48.84 | 6 |
| Drug of abuse screen urine CPT 80305 | $71.83 | $71.83 | $12.60 – $33.01 | 6 |
| Drug screening tapentadol CPT 80372 | not published | not published | $0.02 – $0.02 | 1 |
| Drug screen quant tiagabine CPT 80199 | not published | not published | $27.11 – $71.03 | 6 |
| Drug/substance nos 4-6 CPT 80376 | not published | not published | $0.02 – $0.02 | 1 |
| Drug test def 15-21 classes HCPCS G0482 | not published | not published | $198.74 – $520.70 | 6 |
| Drug test def 1-7 classes HCPCS G0480 | not published | not published | $114.43 – $299.81 | 6 |
| Drug test def 22+ classes HCPCS G0483 | not published | not published | $246.92 – $646.93 | 6 |
| Drug test def 8-14 classes HCPCS G0481 | not published | not published | $156.59 – $410.27 | 6 |
| Drug test def simple all cl HCPCS G0659 | not published | not published | $62.14 – $162.81 | 6 |
| Drug test prsmv instrmnt CPT 80306 | not published | not published | $17.14 – $44.91 | 6 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $71.83 | $71.83 | $62.14 – $162.81 | 6 |
| Drvvt confirm - quest CPT 85597 | not published | not published | $17.98 – $47.11 | 6 |
| Ductogram sgl duct CPT 77053 | not published | not published | $60.60 – $60.60 | 1 |
| Dxa bone density axl vrt fx CPT 77085 | not published | not published | $60.60 – $60.60 | 1 |
| Echo exam of eye CPT 76516 | not published | not published | $40.32 – $40.32 | 1 |
| Echo exam of eye CPT 76519 | not published | not published | $61.72 – $61.72 | 1 |
| Echo exam of eye CPT 76529 | not published | not published | $90.47 – $90.47 | 1 |
| Echo exam of eye thickness CPT 76514 | not published | not published | $5.94 – $5.94 | 1 |
| Echo exam of fetal heart CPT 76825 | not published | not published | $313.40 – $313.40 | 1 |
| Echo exam of fetal heart CPT 76826 | not published | not published | $201.78 – $201.78 | 1 |
| Echo exam of fetal heart CPT 76827 | not published | not published | $72.99 – $72.99 | 1 |
| Echo exam of fetal heart CPT 76828 | not published | not published | $38.63 – $38.63 | 1 |
| Echo exam uterus 76831- CPT 76831 | not published | not published | $139.49 – $139.49 | 1 |
| Echograp trans r pros study CPT 76873 | not published | not published | $165.99 – $165.99 | 1 |
| Echo guidance radiotherapy CPT 76965 | not published | not published | $43.70 – $43.70 | 1 |
| Echo guide for amniocentesis CPT 76946 | not published | not published | $23.40 – $23.40 | 1 |
| Echo guide for artery repair CPT 76936 | not published | not published | $284.11 – $284.11 | 1 |
| Echo guide for heart biopsy CPT 76932 | not published | not published | $98.51 – $98.51 | 1 |
| Echo guide for transfusion CPT 76941 | not published | not published | $88.63 – $88.63 | 1 |
| Echo guide ova aspiration CPT 76948 | not published | not published | $81.46 – $81.46 | 1 |
| Echo guide villus sampling CPT 76945 | not published | not published | $92.01 – $92.01 | 1 |
| E coli 0157 ag ia CPT 87335 | not published | not published | $12.66 – $33.17 | 6 |
| Ed svc ckd grp per session HCPCS G0421 | not published | not published | $27.27 – $71.45 | 6 |
| Ed svc ckd ind per session HCPCS G0420 | not published | not published | $113.10 – $296.32 | 6 |
| E equine encephalitis igg CPT 86652 | not published | not published | $13.19 – $34.56 | 6 |
| Egfr gene com variants CPT 81235 | not published | not published | $324.58 – $850.40 | 6 |
| Ehrlicha chaffeensis amp prb CPT 87484 | not published | not published | $35.09 – $91.94 | 6 |
| Eia hiv-1/hiv-2 screen HCPCS G0432 | not published | not published | $19.57 – $51.27 | 6 |
| Elb disart prosth tiss shap HCPCS L6450 | not published | not published | $3,774.46 – $9,889.09 | 6 |
| Elb mold sock flex hinge pad HCPCS L6100 | not published | not published | $2,890.34 – $7,572.69 | 6 |
| Elbow inter loc elbow forarm HCPCS L6250 | not published | not published | $4,044.42 – $10,596.38 | 6 |
| Elbow mold doub splt soc ste HCPCS L6120 | not published | not published | $3,459.34 – $9,063.47 | 6 |
| Elbow mold outsid lock hinge HCPCS L6200 | not published | not published | $3,900.09 – $10,218.24 | 6 |
| Elbow mold sock suspension t HCPCS L6110 | not published | not published | $3,068.14 – $8,038.53 | 6 |
| Elbow socket ins use without lck HCPCS L6695 | not published | not published | $747.37 – $1,958.11 | 6 |
| Elbow socket ins use w/lock HCPCS L6694 | not published | not published | $896.90 – $2,349.88 | 6 |
| Elbow stump activated lock h HCPCS L6130 | not published | not published | $3,205.49 – $8,398.38 | 6 |
| Elec hand ind art digits HCPCS L6880 | not published | not published | $29,576.80 – $77,491.22 | 6 |
| Elec knee-shin swing/stance HCPCS L5856 | not published | not published | $29,717.20 – $77,859.06 | 6 |
| Elec stim unattend for press HCPCS G0281 | not published | not published | $10.23 – $26.81 | 6 |
| Electrical bone stim 20974 CPT 20974 | not published | not published | $93.71 – $245.52 | 6 |
| Electroconvulsive therapy 90870 CPT 90870 | $2,709.19 | $2,709.19 | $409.27 – $409.27 | 1 |
| Electrodes, pair HCPCS A4556 | not published | not published | $17.31 – $45.35 | 6 |
| Electrolyte panel CPT 80051 | $104.86 | $104.86 | $7.01 – $18.37 | 6 |
| Electromagntic tx for ulcers HCPCS G0329 | not published | not published | $10.55 – $27.64 | 6 |
| Electron elbow child switch HCPCS L7186 | not published | not published | $13,988.10 – $36,648.82 | 6 |
| Electronic elbo simultaneous HCPCS L7181 | not published | not published | $49,600.80 – $129,954.10 | 6 |
| Electronic elbow sequential HCPCS L7180 | not published | not published | $50,007.20 – $131,018.86 | 6 |
| Electron microscopy diagnostic CPT 88348 | not published | not published | $501.89 – $501.89 | 1 |
| Elisa hiv-1/hiv-2 screen HCPCS G0433 | not published | not published | $18.29 – $47.92 | 6 |
| Embolization s&i CPT 75894 | not published | not published | $1,513.93 – $1,513.93 | 1 |
| Embryo hatching CPT 89253 | not published | not published | $333.90 – $333.90 | 1 |
| Emr hd pmp elec/combo, rep HCPCS Q0494 | not published | not published | $265.56 – $695.77 | 6 |
| Emr pwr cbl combo vad, rep HCPCS Q0493 | not published | not published | $313.83 – $822.23 | 6 |
| Emr pwr cbl elec vad, rep HCPCS Q0492 | not published | not published | $110.27 – $288.91 | 6 |
| Emr pwr source combo vad rep HCPCS Q0491 | not published | not published | $1,368.33 – $3,585.02 | 6 |
| Emr pwr source elec vad, rep HCPCS Q0490 | not published | not published | $870.42 – $2,280.50 | 6 |
| Encephalitis, california igg/igm CPT 86651 | not published | not published | $13.19 – $34.56 | 6 |
| Encephalitis, st louis igg/igm CPT 86653 | not published | not published | $13.19 – $34.56 | 6 |
| Encephalitis, western equine igg/igm CPT 86654 | not published | not published | $13.19 – $34.56 | 6 |
| Endo ak/hip alignable system HCPCS L5920 | not published | not published | $866.11 – $2,269.21 | 6 |
| Endo ak/hip knee extens assi HCPCS L5850 | not published | not published | $208.81 – $547.08 | 6 |
| Endo ak ultra-light material HCPCS L5950 | not published | not published | $1,269.97 – $3,327.32 | 6 |
| Endo assay seven anal CPT 81506 | not published | not published | $68.92 – $180.57 | 6 |
| Endo below knee alignable sy HCPCS L5910 | not published | not published | $591.19 – $1,548.92 | 6 |
| Endo bk ultra-light material HCPCS L5940 | not published | not published | $818.79 – $2,145.23 | 6 |
| Endo cath bile duct s&i CPT 74328 | not published | not published | $87.50 – $87.50 | 1 |
| Endo cath panc duct s&i CPT 74329 | not published | not published | $69.43 – $69.43 | 1 |
| Endo hip ultra-light materia HCPCS L5960 | not published | not published | $1,573.63 – $4,122.91 | 6 |
| Endo knee-shin fluid swg/sta HCPCS L5828 | not published | not published | $3,457.19 – $9,057.84 | 6 |
| Endo knee-shin fluid swing p HCPCS L5824 | not published | not published | $2,236.51 – $5,859.66 | 6 |
| Endo knee-shin frct swg & st HCPCS L5812 | not published | not published | $737.66 – $1,932.67 | 6 |
| Endo knee-shin frct swg & st HCPCS L5818 | not published | not published | $1,189.74 – $3,117.12 | 6 |
| Endo knee-shin hydral swg ph HCPCS L5814 | not published | not published | $4,597.46 – $12,045.35 | 6 |
| Endo knee-shin mnl lck ultra HCPCS L5811 | not published | not published | $974.83 – $2,554.05 | 6 |
| Endo knee-shin pneum swg frc HCPCS L5822 | not published | not published | $2,084.77 – $5,462.10 | 6 |
| Endo knee-shin pneum/swg pha HCPCS L5830 | not published | not published | $2,549.61 – $6,679.98 | 6 |
| Endo knee-shin polyc mch sta HCPCS L5816 | not published | not published | $1,186.56 – $3,108.79 | 6 |
| Endo poly hip, pneu/hyd/rot HCPCS L5961 | not published | not published | $5,837.22 – $15,293.52 | 6 |
| Endoscopy swallow (fees) vid CPT 92612 | not published | not published | $197.70 – $517.97 | 6 |
| Endoskeletal axial rotation HCPCS L5984 | not published | not published | $823.06 – $2,156.42 | 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.