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 |
|---|---|---|---|---|
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | not published | not published | $145.73 – $381.81 | 6 |
| Lens iol ant chamb 10.5 HCPCS V2630 | not published | not published | $145.73 – $381.81 | 6 |
| Leukacyte transfusion CPT 86950 | not published | not published | $100.25 – $100.25 | 1 |
| Leukocyte phagocytosis CPT 86344 | not published | not published | $10.39 – $27.22 | 6 |
| Levetiracetam therapeutic drug level CPT 80177 | $502.05 | $502.05 | $13.25 – $34.72 | 6 |
| Lidocaine therapeutic drug level CPT 80176 | $303.37 | $303.37 | $14.69 – $38.49 | 6 |
| Lift assist for elbow HCPCS L6635 | not published | not published | $270.85 – $709.63 | 6 |
| Lift heel adj small gl60404sm HCPCS L3332 | not published | not published | $91.13 – $238.76 | 6 |
| Lift heel adjustable med HCPCS L3334 | not published | not published | $47.13 – $123.48 | 6 |
| Lifts elevation metal extens HCPCS L3330 | not published | not published | $699.23 – $1,831.98 | 6 |
| Limited ankle motion ea jnt HCPCS L2200 | not published | not published | $72.84 – $190.84 | 6 |
| Limited autopsy CPT 88036 | not published | not published | $138.20 – $138.20 | 1 |
| Limited autopsy CPT 88037 | not published | not published | $122.85 – $122.85 | 1 |
| Limited motion knee joint HCPCS L2184 | not published | not published | $171.28 – $448.75 | 6 |
| Lipase CPT 83690 | $182.97 | $182.97 | $6.89 – $18.05 | 6 |
| Lipoprotein blood high res frac & quant CPT 83701 | not published | not published | $33.86 – $88.71 | 6 |
| Lipoprotein blood quant CPT 83704 | not published | not published | $34.19 – $89.58 | 6 |
| Lipoprotein direct measurement hdl CPT 83718 | $348.16 | $348.16 | $8.19 – $21.46 | 6 |
| Lipoprotein direct measurement ldl CPT 83721 | not published | not published | $10.50 – $27.51 | 6 |
| Lipoprtn dir meas sd ldl chl CPT 83722 | not published | not published | $34.19 – $89.58 | 6 |
| Listeria monocytogenes CPT 86723 | not published | not published | $13.19 – $34.56 | 6 |
| Lith ion batt cid, ear level HCPCS L8624 | not published | not published | $199.61 – $522.98 | 6 |
| Lith ion batt cid,non-earlvl HCPCS L8623 | not published | not published | $80.05 – $209.73 | 6 |
| Lithium ion battery charger HCPCS L7368 | not published | not published | $624.79 – $1,636.95 | 6 |
| Lithium therapeutic drug level CPT 80178 | $335.93 | $335.93 | $6.61 – $17.32 | 6 |
| Liver ds alys 3 bmrk srm alg CPT 81517 | not published | not published | $176.19 – $461.62 | 6 |
| Liver Function Test CPT 80076 | $563.99 | $563.99 | $8.17 – $21.41 | 6 |
| Liver imaging CPT 78201 | not published | not published | $270.00 – $270.00 | 1 |
| Liver imag w/vasclr flow CPT 78202 | not published | not published | $297.63 – $297.63 | 1 |
| Liver/spleen imag static only CPT 78215 | not published | not published | $274.53 – $274.53 | 1 |
| Liver/spleen imag w/vasclr flow CPT 78216 | not published | not published | $169.70 – $169.70 | 1 |
| Lockingelbow forearm cntrbal HCPCS L6693 | not published | not published | $3,514.41 – $9,207.75 | 6 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | not published | not published | $2.41 – $2.41 | 1 |
| Long tongue stirrup HCPCS L2265 | not published | not published | $180.44 – $472.75 | 6 |
| Lo rig pos pnl l1-l5 pre ots HCPCS L0641 | not published | not published | $57.10 – $149.60 | 6 |
| Lo sag rig pnl stays pre cst HCPCS L0626 | not published | not published | $96.31 – $252.33 | 6 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | not published | not published | $584.00 – $584.00 | 1 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | not published | not published | $584.00 – $584.00 | 1 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | not published | not published | $584.00 – $584.00 | 1 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | not published | not published | $761.00 – $761.00 | 1 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | not published | not published | $761.00 – $761.00 | 1 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | not published | not published | $761.00 – $761.00 | 1 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $815.31 | $815.31 | $48.77 – $48.77 | 1 |
| Low frequency non-thermal Ultrasound CPT 97610 | not published | not published | $392.17 – $1,027.49 | 6 |
| Lso corset front HCPCS L0972 | not published | not published | $152.77 – $400.26 | 6 |
| Lso flex no ri stays pre ots HCPCS L0628 | not published | not published | $61.45 – $161.00 | 6 |
| Lso full corset HCPCS L0976 | not published | not published | $216.26 – $566.60 | 6 |
| Lso r post pnl sj-t9 pre cst HCPCS L0630 | not published | not published | $200.06 – $524.16 | 6 |
| Lso sag-coronal panel custom HCPCS L0638 | not published | not published | $1,629.51 – $4,269.32 | 6 |
| Lso sag-co shell pnl pre ots HCPCS L0651 | not published | not published | $870.15 – $2,279.79 | 6 |
| Lso sag ctr rigi pos pre ots HCPCS L0643 | not published | not published | $118.63 – $310.81 | 6 |
| Lso sagit rigid panel prefab HCPCS L0635 | not published | not published | $1,222.44 – $3,202.79 | 6 |
| Lso sagittal rigid panel cus HCPCS L0636 | not published | not published | $1,657.19 – $4,341.84 | 6 |
| Lso sc r pos/lat pnl pre cst HCPCS L0633 | not published | not published | $354.31 – $928.29 | 6 |
| Lso sc r pos/lat pnl pre ots HCPCS L0649 | not published | not published | $210.07 – $550.38 | 6 |
| Lso s/c shell/panel custom HCPCS L0640 | not published | not published | $1,292.78 – $3,387.08 | 6 |
| Lso s/c shell/panel prefab HCPCS L0639 | not published | not published | $1,501.02 – $3,932.67 | 6 |
| L/s ratio fetal lung CPT 83661 | not published | not published | $21.99 – $57.61 | 6 |
| Lubricant per ounce HCPCS A4402 | not published | not published | $2.27 – $5.95 | 6 |
| Lumbar bolster pad HCPCS L1030 | not published | not published | $97.47 – $255.37 | 6 |
| Lumbar derotation pad HCPCS L1240 | not published | not published | $96.35 – $252.44 | 6 |
| Lumbar diskogram s&i CPT 72295 | not published | not published | $122.04 – $122.04 | 1 |
| Lumbar or lumbar rib pad HCPCS L1040 | not published | not published | $101.89 – $266.95 | 6 |
| Lumbar sling HCPCS L1090 | not published | not published | $117.80 – $308.64 | 6 |
| Lung perfusion imaging CPT 78580 | not published | not published | $318.49 – $318.49 | 1 |
| Lvad shower bag heartmate HCPCS Q0501 | not published | not published | $632.22 – $1,656.42 | 6 |
| Lwr ext dynamic prosth pylon HCPCS L5985 | not published | not published | $349.54 – $915.79 | 6 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $20.05 – $52.53 | 6 |
| Lymphatics/lymph node imaging CPT 78195 | not published | not published | $470.94 – $470.94 | 1 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $36.56 – $95.79 | 6 |
| Lymphocyte transformation mitogen CPT 86353 | not published | not published | $49.03 – $128.46 | 6 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $189.51 – $496.52 | 6 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $47.59 – $124.69 | 6 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $898.61 – $898.61 | 1 |
| Lymph vessel x-ray arms/legs CPT 75803 | not published | not published | $2,338.48 – $2,338.48 | 1 |
| Lymph vessel x-ray trunk CPT 75805 | not published | not published | $4,760.60 – $4,760.60 | 1 |
| Lymph vessel x-ray trunk CPT 75807 | not published | not published | $4,760.60 – $4,760.60 | 1 |
| Macro exam dissect molec study ea CPT 88387 | not published | not published | $10.18 – $10.18 | 1 |
| Macroscopic exam arthropod CPT 87168 | not published | not published | $4.27 – $11.19 | 6 |
| Macroscopic exam parasite CPT 87169 | not published | not published | $4.31 – $11.29 | 6 |
| Magnesium CPT 83735 | $69.92 | $69.92 | $6.70 – $17.55 | 6 |
| Magnetic image bone marrow CPT 77084 | not published | not published | $761.00 – $761.00 | 1 |
| Malaria antibody CPT 86750 | not published | not published | $13.19 – $34.56 | 6 |
| Man's shoe oxford brace HCPCS L3225 | not published | not published | $79.22 – $207.56 | 6 |
| Manual diff wbc count b-coat CPT 85009 | not published | not published | $5.07 – $13.28 | 6 |
| Mask full face lg af531 HCPCS A7030 | not published | not published | $109.65 – $287.28 | 6 |
| Mastectomy form HCPCS L8020 | not published | not published | $278.14 – $728.73 | 6 |
| Mastoids complete CPT 70130 | not published | not published | $78.08 – $78.08 | 1 |
| M.avium-intra dna amp prob CPT 87561 | not published | not published | $35.09 – $91.94 | 6 |
| M.avium-intra dna dir prob CPT 87560 | not published | not published | $27.29 – $71.50 | 6 |
| M.avium-intra dna quant CPT 87562 | not published | not published | $42.84 – $112.24 | 6 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | not published | not published | $14.46 – $37.89 | 6 |
| Mayo aathr protein s free CPT 85306 | not published | not published | $15.32 – $40.14 | 6 |
| Mayo activated protein c resistance assay CPT 85307 | not published | not published | $15.32 – $40.14 | 6 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | not published | not published | $38.57 – $101.05 | 6 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | not published | not published | $0.02 – $0.02 | 1 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $315.63 | $315.63 | $0.02 – $0.02 | 1 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | not published | not published | $14.78 – $38.72 | 6 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | not published | not published | $0.02 – $0.02 | 1 |
| Mayo alpha 1 antitrypsin CPT 82103 | not published | not published | $13.44 – $35.21 | 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.