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 |
|---|---|---|---|---|
| Infect ag if ea plyvlnt antsrm CPT 87300 | not published | not published | $11.98 – $31.39 | 6 |
| Infect ag if hep delta agent CPT 87380 | not published | not published | $18.36 – $48.10 | 6 |
| Infect ag if influenza a CPT 87276 | not published | not published | $16.07 – $42.10 | 6 |
| Infect ag if influenza b CPT 87275 | not published | not published | $12.25 – $32.09 | 6 |
| Infect ag if legionella pneumophila CPT 87278 | not published | not published | $15.60 – $40.87 | 6 |
| Infect ag if nos ea CPT 87299 | not published | not published | $16.10 – $42.18 | 6 |
| Infect ag if pneumocystis carinii CPT 87281 | not published | not published | $11.98 – $31.39 | 6 |
| Infect ag if varicella zoster CPT 87290 | not published | not published | $13.42 – $35.16 | 6 |
| Infect ag na chlamydia trachomatis qnt CPT 87492 | not published | not published | $53.47 – $140.09 | 6 |
| Infect ag na hep b amp CPT 87516 | not published | not published | $35.09 – $91.94 | 6 |
| Infect ag na herpes simplex quant CPT 87530 | not published | not published | $42.84 – $112.24 | 6 |
| Infect ag na hpv high-risk types CPT 87624 | not published | not published | $35.09 – $91.94 | 6 |
| Infect ag na influenza r/amp 1st 2 types CPT 87502 | not published | not published | $95.80 – $251.00 | 6 |
| Infect ag na influenza revr/amp ea type CPT 87501 | not published | not published | $51.31 – $134.43 | 6 |
| Infect ag na orthopoxvirus amp prb each CPT 87593 | not published | not published | $51.31 – $134.43 | 6 |
| Infect ag na resp virus 12-25 targets CPT 87633 | not published | not published | $416.78 – $1,091.96 | 6 |
| Infect ag phenotype na hiv-1 1-10 drugs CPT 87903 | not published | not published | $488.66 – $1,280.29 | 6 |
| Infect ag phenotype na hiv-1 ea addl drg CPT 87904 | not published | not published | $26.07 – $68.30 | 6 |
| Infectious agent antigen immunoassay direct optical observation sars-cov-2 CPT 87811 | not published | not published | $41.38 – $108.42 | 6 |
| Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin CPT 87324 | not published | not published | $11.98 – $31.39 | 6 |
| Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans CPT 87327 | not published | not published | $13.42 – $35.16 | 6 |
| Infectious agent antigen immunoassay ql/sq multi step cryptosporidium CPT 87328 | not published | not published | $13.82 – $36.21 | 6 |
| Infectious agent antigen immunoassay ql/sq multi step giardia CPT 87329 | not published | not published | $11.98 – $31.39 | 6 |
| Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool CPT 87338 | not published | not published | $14.38 – $37.68 | 6 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn CPT 87340 | $69.92 | $69.92 | $10.33 – $27.06 | 6 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization CPT 87341 | not published | not published | $10.33 – $27.06 | 6 |
| Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies CPT 87389 | $187.44 | $187.44 | $24.08 – $63.09 | 6 |
| Infectious agent antigen immunoassay ql/sq multi step legionella urine CPT 87449 | not published | not published | $11.98 – $31.39 | 6 |
| Infectious agent antigen immunoassay ql/sq multi step rotavirus CPT 87425 | not published | not published | $11.98 – $31.39 | 6 |
| Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin CPT 87427 | not published | not published | $11.98 – $31.39 | 6 |
| Infectious agent nucleic acid amplified probe CPT 87798 | $310.94 | $310.94 | $35.09 – $91.94 | 6 |
| Infectious agent nucleic acid amplified probe chlamydia trachomatis CPT 87491 | $333.18 | $333.18 | $35.09 – $91.94 | 6 |
| Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s) CPT 87493 | not published | not published | $37.27 – $97.65 | 6 |
| Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets CPT 87483 | not published | not published | $416.78 – $1,091.96 | 6 |
| Infectious agent nucleic acid amplified probe hsv-1 CPT 87529 | not published | not published | $35.09 – $91.94 | 6 |
| Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus CPT 87641 | not published | not published | $35.09 – $91.94 | 6 |
| Infectious agent nucleic acid amplified probe mycobacteria tuberculosis CPT 87556 | not published | not published | $41.68 – $109.20 | 6 |
| Infectious agent nucleic acid amplified probe neisseria gonorrhoeae CPT 87591 | $333.18 | $333.18 | $35.09 – $91.94 | 6 |
| Infectious agent nucleic acid amplified probe sars-cov-2/covid-19 CPT 87635 | not published | not published | $51.31 – $134.43 | 6 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b CPT 87636 | not published | not published | $142.63 – $373.69 | 6 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv CPT 87637 | not published | not published | $142.63 – $373.69 | 6 |
| Infectious agent nucleic acid amplified probe streptococcus group a CPT 87651 | not published | not published | $35.09 – $91.94 | 6 |
| Infectious agent nucleic acid amplified probe trichomonas vaginalis CPT 87661 | not published | not published | $35.09 – $91.94 | 6 |
| Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae CPT 87494 | not published | not published | $70.18 – $183.87 | 6 |
| Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance CPT 87564 | not published | not published | $76.77 – $201.14 | 6 |
| Infectious agent nucleic acid joint space pathogens multiplex amplified probe >= 26 targets CPT 87627 | not published | not published | $679.77 – $1,781.00 | 6 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets CPT 87507 | not published | not published | $416.78 – $1,091.96 | 6 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets CPT 87505 | not published | not published | $128.29 – $336.12 | 6 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets CPT 87506 | not published | not published | $262.99 – $689.03 | 6 |
| Infectious agent nucleic acid quantification bk virus CPT 87799 | not published | not published | $42.84 – $112.24 | 6 |
| Infectious agent nucleic acid quantification hepatitis b CPT 87517 | not published | not published | $42.84 – $112.24 | 6 |
| Infectious agent nucleic acid quantification hepatitis c CPT 87522 | not published | not published | $42.84 – $112.24 | 6 |
| Infectious agent nucleic acid quantification hiv-1 CPT 87536 | not published | not published | $85.10 – $222.96 | 6 |
| Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets CPT 87631 | not published | not published | $142.63 – $373.69 | 6 |
| Influenza dna amp prob addl CPT 87503 | not published | not published | $29.22 – $76.56 | 6 |
| Infuse radioactive materials CPT 77750 | not published | not published | $224.15 – $224.15 | 1 |
| Init ak ischal plstr direct HCPCS L5505 | not published | not published | $2,839.14 – $7,438.55 | 6 |
| Init bk ptb plaster direct HCPCS L5500 | not published | not published | $1,756.84 – $4,602.92 | 6 |
| Initial custom socket insert HCPCS L5683 | not published | not published | $1,628.34 – $4,266.25 | 6 |
| Inj bulking agent anal canal HCPCS L8605 | not published | not published | $886.61 – $2,322.92 | 6 |
| Inj fe-based mr contrast,1ml HCPCS Q9953 | not published | not published | $35.89 – $35.89 | 1 |
| Inj multihance HCPCS A9577 | not published | not published | $4.68 – $4.68 | 1 |
| Inj multihance multipack HCPCS A9578 | not published | not published | $4.68 – $4.68 | 1 |
| Inj prohance multipack HCPCS A9576 | not published | not published | $3.71 – $3.71 | 1 |
| Inj vocal cord bulking agent HCPCS L8607 | not published | not published | $53.11 – $139.15 | 6 |
| Insemination of oocytes CPT 89268 | not published | not published | $626.57 – $626.57 | 1 |
| Insert tray without bag/cath HCPCS A4310 | not published | not published | $9.36 – $24.52 | 6 |
| Insitu hybridization auto CPT 88367 | not published | not published | $105.92 – $105.92 | 1 |
| Insitu hybridization (fish) CPT 88366 | not published | not published | $296.76 – $296.76 | 1 |
| Insitu hybridization manual CPT 88368 | not published | not published | $126.03 – $126.03 | 1 |
| In situ hybridization per specimen each additional single probe stain CPT 88364 | not published | not published | $137.99 – $137.99 | 1 |
| In situ hybridization per specimen initial single probe stain CPT 88365 | not published | not published | $181.13 – $181.13 | 1 |
| Insole orthotic freedom sz6 6816 HCPCS L3060 | not published | not published | $91.13 – $238.76 | 6 |
| Insulin suppression panel CPT 80432 | not published | not published | $165.61 – $433.90 | 6 |
| Insulin tolerance panel CPT 80434 | not published | not published | $285.03 – $746.78 | 6 |
| Insulin tolerance panel CPT 80435 | not published | not published | $103.00 – $269.86 | 6 |
| Insulin total CPT 83525 | not published | not published | $11.43 – $29.95 | 6 |
| Interphalangeal joint spacer HCPCS L8658 | not published | not published | $373.64 – $978.94 | 6 |
| Interscap-thor myoelectronic HCPCS L6975 | not published | not published | $23,640.70 – $61,938.63 | 6 |
| Interscapular-thor switch CT HCPCS L6970 | not published | not published | $23,514.50 – $61,607.99 | 6 |
| Intl custm cong/latyp insert HCPCS L5681 | not published | not published | $1,628.34 – $4,266.25 | 6 |
| Intrinsic factor antibody CPT 86340 | not published | not published | $15.08 – $39.51 | 6 |
| Intro long gi tube w/mult fluo CPT 74340 | not published | not published | $127.03 – $127.03 | 1 |
| Iodine i-123 sod iodide mil HCPCS A9509 | not published | not published | $499.69 – $499.69 | 1 |
| Iopamidol 250 mg iodine/ml (51 %) intravenous solution HCPCS Q9966 | not published | not published | $1.05 – $1.05 | 1 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | not published | not published | $0.36 – $0.36 | 1 |
| Io radiation tx management CPT 77469 | not published | not published | $545.13 – $545.13 | 1 |
| Io rad tx deliver by elctrns CPT 77425 | not published | not published | $532.51 – $532.51 | 1 |
| Io rad tx delivery by x-ray CPT 77424 | not published | not published | $754.61 – $754.61 | 1 |
| Ioxaglate 39.3%-19.6% inj 200 ml HCPCS Q9964 | not published | not published | $0.84 – $0.84 | 1 |
| Iron CPT 83540 | $70.53 | $70.53 | $6.47 – $16.95 | 6 |
| Iron binding capacity CPT 83550 | $78.43 | $78.43 | $8.74 – $22.90 | 6 |
| Iron stain peripheral blood CPT 85536 | not published | not published | $6.88 – $18.03 | 6 |
| Irradiation of blood product each unit reference CPT 86945 | not published | not published | $38.39 – $38.39 | 1 |
| Irrigation syringe HCPCS A4322 | not published | not published | $4.02 – $10.53 | 6 |
| Irrigation tray HCPCS A4320 | not published | not published | $6.47 – $16.95 | 6 |
| Ivc venogram s&i CPT 75825 | not published | not published | $103.99 – $103.99 | 1 |
| IV inj ra drug dx study CPT 78808 | not published | not published | $66.51 – $66.51 | 1 |
| Ivp w/nephrotomography CPT 74415 | not published | not published | $227.40 – $227.40 | 1 |
| Ivp w/wo kub w/wo tomography CPT 74400 | not published | not published | $194.15 – $194.15 | 1 |
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.