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 |
|---|---|---|---|---|
| Ortho elbow w/lock w/ft&adj HCPCS L3760 | not published | not published | $562.31 – $1,473.25 | 6 |
| Ortho ewhf rigd without jnt cstm w HCPCS L3765 | not published | not published | $1,441.77 – $3,777.44 | 6 |
| Ortho ewh rgd without jnt cstm w/fit&adj HCPCS L3763 | not published | not published | $787.21 – $2,062.49 | 6 |
| Ortho hnd/fngr without jnt cstm w/fit&adj HCPCS L3913 | not published | not published | $304.55 – $797.92 | 6 |
| Ortho hnd/fngr w/jnt cstm w/fit&adj HCPCS L3921 | not published | not published | $361.14 – $946.19 | 6 |
| Ortho hnd metcrpl fx prefb w/fit&adj HCPCS L3917 | not published | not published | $118.75 – $311.13 | 6 |
| Ortho hnd without jnt w/fit&adj HCPCS L3919 | not published | not published | $304.55 – $797.92 | 6 |
| Orthopantogram CPT 70355 | not published | not published | $13.26 – $13.26 | 1 |
| Orthopedic shoe add rub insl HCPCS L3510 | not published | not published | $36.18 – $94.79 | 6 |
| Ortho shoe add full sole HCPCS L3540 | not published | not published | $62.84 – $164.64 | 6 |
| Ortho shoe add half sole HCPCS L3530 | not published | not published | $39.27 – $102.89 | 6 |
| Ortho shoe add leather insol HCPCS L3500 | not published | not published | $36.18 – $94.79 | 6 |
| Ortho shoe add march bar HCPCS L3595 | not published | not published | $51.84 – $135.82 | 6 |
| Ortho sidebar disconnect HCPCS L2768 | not published | not published | $160.94 – $421.66 | 6 |
| Orthosis lso rigd frm hyperex HCPCS L0472 | not published | not published | $511.39 – $1,339.84 | 6 |
| Ortho whf rigd without jnt cstm w/fit&adj HCPCS L3808 | not published | not published | $375.75 – $984.47 | 6 |
| Ortho wrst/hnd w/jnt cstm w/fit&adj HCPCS L3905 | not published | not published | $1,115.05 – $2,921.43 | 6 |
| O shoe add felt w leath insl HCPCS L3520 | not published | not published | $39.27 – $102.89 | 6 |
| O shoe add horseshoe toe tap HCPCS L3560 | not published | not published | $28.26 – $74.04 | 6 |
| O shoe add instep extension HCPCS L3570 | not published | not published | $105.25 – $275.75 | 6 |
| O shoe add instep velcro clo HCPCS L3580 | not published | not published | $80.14 – $209.97 | 6 |
| O shoe add standard toe tap HCPCS L3550 | not published | not published | $11.02 – $28.87 | 6 |
| O shoe convert to sof counte HCPCS L3590 | not published | not published | $66.01 – $172.95 | 6 |
| Osmolality blood CPT 83930 | $152.90 | $152.90 | $6.61 – $17.32 | 6 |
| Osmolality urine CPT 83935 | $166.26 | $166.26 | $6.82 – $17.87 | 6 |
| Ostomy clamp, replacement HCPCS A4363 | not published | not published | $3.38 – $8.86 | 6 |
| Ostomy irrigation set HCPCS A4400 | not published | not published | $69.65 – $182.48 | 6 |
| Ost pch drain 2 piece system HCPCS A4426 | not published | not published | $3.89 – $10.19 | 6 |
| Ost pch drain for barrier fl HCPCS A4425 | not published | not published | $5.10 – $13.36 | 6 |
| Ost pch drain w bar & filter HCPCS A4424 | not published | not published | $6.78 – $17.76 | 6 |
| Ost pch for bar w flange/flt HCPCS A4419 | not published | not published | $2.46 – $6.45 | 6 |
| Ost skn barr extnd >4 sq HCPCS A4410 | not published | not published | $12.88 – $33.75 | 6 |
| Ost urine pch w b/bltin conv HCPCS A4430 | not published | not published | $12.14 – $31.81 | 6 |
| Ot evaluation high complexity patient/family CPT 97167 | $1,098.42 | $1,098.42 | $88.24 – $231.18 | 6 |
| Ot evaluation low complexity patient/family CPT 97165 | $550.66 | $550.66 | $88.24 – $231.18 | 6 |
| Ot evaluation moderate complexity patient/family CPT 97166 | $824.55 | $824.55 | $88.24 – $231.18 | 6 |
| Other immunoelectrophoresis CPT 86325 | not published | not published | $23.13 – $60.60 | 6 |
| Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes CPT 97763 | $322.90 | $322.90 | $43.76 – $114.66 | 6 |
| Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes CPT 97760 | $383.43 | $383.43 | $40.30 – $105.57 | 6 |
| Ot manual therpy techniques >=1 region each 15 minutes CPT 97140 | not published | not published | $24.31 – $63.70 | 6 |
| Ot re-evaluation patient/family CPT 97168 | $371.91 | $371.91 | $60.02 – $157.27 | 6 |
| Ot therapeutic activities direct patient contact each 15 minutes CPT 97530 | not published | not published | $30.69 – $80.42 | 6 |
| Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes CPT 97130 | not published | not published | $21.12 – $55.33 | 6 |
| Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes CPT 97129 | $108.12 | $108.12 | $19.72 – $51.67 | 6 |
| Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes CPT 97110 | not published | not published | $25.48 – $66.77 | 6 |
| Ot therapeutic procedure neuromuscular reeducate each 15 minutes CPT 97112 | not published | not published | $28.71 – $75.21 | 6 |
| Ot training self care/home management direct contact each 15 minutes CPT 97535 | not published | not published | $28.38 – $74.36 | 6 |
| Outrigger HCPCS L1080 | not published | not published | $65.87 – $172.58 | 6 |
| Outrigger bil with vert extens HCPCS L1085 | not published | not published | $198.91 – $521.14 | 6 |
| Ovulation tests CPT 84830 | not published | not published | $12.70 – $33.27 | 6 |
| Pabpn1 gene detc abnor allel CPT 81312 | not published | not published | $137.00 – $358.94 | 6 |
| Packing strips, non-impreg HCPCS A6407 | not published | not published | $2.66 – $6.97 | 6 |
| Palb2 gene full gene seq CPT 81307 | not published | not published | $676.50 – $1,772.43 | 6 |
| Palb2 gene known famil vrnt CPT 81308 | not published | not published | $301.35 – $789.54 | 6 |
| Parathormone (pth) intact CPT 83970 | not published | not published | $41.28 – $108.15 | 6 |
| Parathyrd planar w/spect&ct CPT 78072 | not published | not published | $746.55 – $746.55 | 1 |
| Parathyroid planar imaging CPT 78070 | not published | not published | $404.15 – $404.15 | 1 |
| Parathyroid planar img w/tomo spect CPT 78071 | not published | not published | $464.18 – $464.18 | 1 |
| Passy muir valve metal trach HCPCS L8501 | not published | not published | $147.88 – $387.45 | 6 |
| Paste skin barrier .5oz adapt HCPCS A4406 | not published | not published | $8.16 – $21.38 | 6 |
| Pathogen reduced plasma pool HCPCS P9070 | not published | not published | $1,484.00 – $1,484.00 | 1 |
| Patten bottom HCPCS L2370 | not published | not published | $337.23 – $883.54 | 6 |
| Pca3/klk3 antigen CPT 81313 | not published | not published | $255.05 – $668.23 | 6 |
| Pdgfra gene CPT 81314 | not published | not published | $329.51 – $863.32 | 6 |
| Pd hl 3.5in 4d med rbr mld 6432 HCPCS L3350 | not published | not published | $28.26 – $74.04 | 6 |
| Pediatric electric hand HCPCS L7008 | not published | not published | $8,840.49 – $23,162.08 | 6 |
| Pediatric electric hook HCPCS L7045 | not published | not published | $2,638.38 – $6,912.56 | 6 |
| Ped term dev, hand, vol clos HCPCS L6714 | not published | not published | $1,638.09 – $4,291.80 | 6 |
| Ped term dev, hand, vol open HCPCS L6713 | not published | not published | $1,933.98 – $5,067.03 | 6 |
| Ped term dev, hook, vol clos HCPCS L6712 | not published | not published | $1,532.40 – $4,014.89 | 6 |
| Ped term dev, hook, vol open HCPCS L6711 | not published | not published | $832.27 – $2,180.55 | 6 |
| Pelv band/spread bar thigh c HCPCS L1640 | not published | not published | $610.60 – $1,599.77 | 6 |
| Pelvic band & belt thigh fla HCPCS L2192 | not published | not published | $453.23 – $1,187.46 | 6 |
| Pelvic control band & belt b HCPCS L2640 | not published | not published | $442.33 – $1,158.90 | 6 |
| Pelvic control band & belt u HCPCS L2630 | not published | not published | $336.48 – $881.58 | 6 |
| Pelvic control hip heavy dut HCPCS L2620 | not published | not published | $359.52 – $941.94 | 6 |
| Pelvic control pelvic sling HCPCS L2580 | not published | not published | $533.32 – $1,397.30 | 6 |
| Pelvic CT scan (with and without contrast) CPT 72194 | not published | not published | $584.00 – $584.00 | 1 |
| Pelvic CT scan (with contrast) CPT 72193 | not published | not published | $584.00 – $584.00 | 1 |
| Pelvic CT scan (without contrast) CPT 72192 | not published | not published | $584.00 – $584.00 | 1 |
| Pelvic & hip control thigh c HCPCS L1680 | not published | not published | $1,655.15 – $4,336.49 | 6 |
| Pelvic MRI (with and without contrast) CPT 72197 | not published | not published | $761.00 – $761.00 | 1 |
| Pelvic MRI (with contrast) CPT 72196 | not published | not published | $761.00 – $761.00 | 1 |
| Pelvic MRI (without contrast) CPT 72195 | not published | not published | $761.00 – $761.00 | 1 |
| Pelvic Ultrasound (complete) CPT 76856 | not published | not published | $124.29 – $124.29 | 1 |
| Pelvic Ultrasound (limited) CPT 76857 | not published | not published | $40.88 – $40.88 | 1 |
| Pelv & thor control gluteal HCPCS L2650 | not published | not published | $166.13 – $435.26 | 6 |
| Peritoneogram rs&i CPT 74190 | not published | not published | $803.35 – $803.35 | 1 |
| Perit-vens shunt pat tst CPT 78291 | not published | not published | $347.78 – $347.78 | 1 |
| Peroneal straps pair pre ots HCPCS L0980 | not published | not published | $26.75 – $70.09 | 6 |
| Perp bk ptb thermopls direct HCPCS L5520 | not published | not published | $2,347.37 – $6,150.11 | 6 |
| Pertussis ag if CPT 87265 | not published | not published | $11.98 – $31.39 | 6 |
| Pessary 3.5 in 7 vag sil rng fold HCPCS A4562 | not published | not published | $72.96 – $191.16 | 6 |
| Pessary reusable rub anytype HCPCS A4561 | not published | not published | $29.33 – $76.84 | 6 |
| Pet CT skull-mid thgh initial CPT 78815 | not published | not published | $2,291.20 – $2,291.20 | 1 |
| Pet CT whole body initial CPT 78816 | not published | not published | $2,291.20 – $2,291.20 | 1 |
| Pet fdg brain metoblic eval sb CPT 78608 | not published | not published | $2,291.20 – $2,291.20 | 1 |
| Pet image full body CPT 78813 | not published | not published | $2,291.20 – $2,291.20 | 1 |
| Pet image ltd area CPT 78811 | not published | not published | $2,291.20 – $2,291.20 | 1 |
| Pet image skull-thigh CPT 78812 | not published | not published | $2,291.20 – $2,291.20 | 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.