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 |
|---|---|---|---|---|
| Rbc serum pretx incubj drugs CPT 86975 | not published | not published | $41.55 – $41.55 | 1 |
| Red blood cells each unit HCPCS P9021 | not published | not published | $155.99 – $155.99 | 1 |
| Red blood cells frozen/deglycerolized/washed leukocytes reduced irradiated each unit HCPCS P9057 | not published | not published | $1,149.21 – $1,149.21 | 1 |
| Red blood cells leukocytes reduced cmv negative irradiated each unit HCPCS P9058 | not published | not published | $152.43 – $152.43 | 1 |
| Red blood cells leukocytes reduced each unit HCPCS P9016 | not published | not published | $509.18 – $509.18 | 1 |
| Red blood cells leukocytes reduced irradiated each unit HCPCS P9040 | not published | not published | $573.04 – $573.04 | 1 |
| Red blood cells washed each unit HCPCS P9022 | not published | not published | $351.35 – $351.35 | 1 |
| Red cell mass multiple CPT 78121 | not published | not published | $107.70 – $107.70 | 1 |
| Red cell mass single CPT 78120 | not published | not published | $102.63 – $102.63 | 1 |
| Red cell sequestration CPT 78140 | not published | not published | $143.21 – $143.21 | 1 |
| Red cell survival study CPT 78130 | not published | not published | $166.63 – $166.63 | 1 |
| Reinforced solid stirrup HCPCS L2260 | not published | not published | $237.72 – $622.83 | 6 |
| Remot img sub by pt, non e/m HCPCS G2250 | not published | not published | $12.94 – $33.90 | 6 |
| Removable insert each HCPCS L6691 | not published | not published | $422.60 – $1,107.21 | 6 |
| Removable soft interface le HCPCS K0672 | not published | not published | $104.75 – $274.44 | 6 |
| Remove cva lumen obstruct CPT 75902 | not published | not published | $127.10 – $127.10 | 1 |
| Remove esophagus obstruction CPT 74235 | not published | not published | $172.75 – $172.75 | 1 |
| Renal cyst study s&i CPT 74470 | not published | not published | $803.35 – $803.35 | 1 |
| Renal function panel CPT 80069 | $310.69 | $310.69 | $8.68 – $22.74 | 6 |
| Renal venogram bil s&i CPT 75833 | not published | not published | $131.35 – $131.35 | 1 |
| Renin stimulation panel CPT 80416 | not published | not published | $209.32 – $548.42 | 6 |
| Renin stimulation panel CPT 80417 | not published | not published | $43.99 – $115.25 | 6 |
| Repair prosthesis per 15 min HCPCS L7520 | not published | not published | $40.67 – $106.56 | 6 |
| Replace afo soft interface HCPCS L4392 | not published | not published | $29.10 – $76.24 | 6 |
| Replace foot drop spint HCPCS L4394 | not published | not published | $21.24 – $55.65 | 6 |
| Replace high roll cuff HCPCS L4060 | not published | not published | $365.19 – $956.80 | 6 |
| Replacemnt lithium ionbatter HCPCS L7367 | not published | not published | $481.93 – $1,262.66 | 6 |
| Replace molded calf lacer HCPCS L4050 | not published | not published | $474.40 – $1,242.93 | 6 |
| Replace molded thigh lacer HCPCS L4040 | not published | not published | $493.23 – $1,292.26 | 6 |
| Replace non-molded calf lace HCPCS L4055 | not published | not published | $312.94 – $819.90 | 6 |
| Replace non-molded thigh lac HCPCS L4045 | not published | not published | $376.94 – $987.58 | 6 |
| Replace pretibial shell HCPCS L4130 | not published | not published | $664.47 – $1,740.91 | 6 |
| Replace prox & dist upright HCPCS L4070 | not published | not published | $407.08 – $1,066.55 | 6 |
| Replace quadlat socket brim HCPCS L4020 | not published | not published | $1,157.21 – $3,031.89 | 6 |
| Replace socket above knee HCPCS L5701 | not published | not published | $4,212.11 – $11,035.73 | 6 |
| Replace socket below knee HCPCS L5700 | not published | not published | $3,507.38 – $9,189.34 | 6 |
| Replace socket brim cust fit HCPCS L4030 | not published | not published | $756.75 – $1,982.69 | 6 |
| Replace socket hip HCPCS L5702 | not published | not published | $5,328.96 – $13,961.88 | 6 |
| Replace trilateral socket br HCPCS L4010 | not published | not published | $791.32 – $2,073.26 | 6 |
| Repl alkaline battery HCPCS L8622 | not published | not published | $0.40 – $1.05 | 6 |
| Replc sockt above elbow disa HCPCS L6884 | not published | not published | $3,428.45 – $8,982.54 | 6 |
| Replc sockt below e/w disa HCPCS L6883 | not published | not published | $2,284.39 – $5,985.10 | 6 |
| Replc sockt shldr dis/interc HCPCS L6885 | not published | not published | $3,899.44 – $10,216.53 | 6 |
| Repl cushions for jaw motion HCPCS E1701 | not published | not published | $14.41 – $37.75 | 6 |
| Repl girdle milwaukee orth HCPCS L4000 | not published | not published | $1,548.39 – $4,056.78 | 6 |
| Repl leath cuff kafo-afo cal HCPCS L4110 | not published | not published | $107.83 – $282.51 | 6 |
| Repl leath cuff kafo prox th HCPCS L4100 | not published | not published | $134.81 – $353.20 | 6 |
| Repl met band kafo-afo calf/ HCPCS L4090 | not published | not published | $131.28 – $343.95 | 6 |
| Repl met band kafo-afo prox HCPCS L4080 | not published | not published | $116.23 – $304.52 | 6 |
| Repl trach puncture dilator HCPCS L8514 | not published | not published | $116.73 – $305.83 | 6 |
| Repl zinc air battery HCPCS L8621 | not published | not published | $0.77 – $2.02 | 6 |
| Reptilase test CPT 85635 | not published | not published | $9.85 – $25.81 | 6 |
| Respirator motion mgmt simul CPT 77293 | not published | not published | $556.19 – $556.19 | 1 |
| #resp virpnl dfa-adenovirus CPT 87260 | not published | not published | $14.43 – $37.81 | 6 |
| #resp virpnl dfa-parainfluenza CPT 87279 | not published | not published | $16.43 – $43.05 | 6 |
| Resp virus 6-11 targets CPT 87632 | not published | not published | $218.06 – $571.32 | 6 |
| Reticulated platelet assay CPT 85055 | not published | not published | $35.74 – $93.64 | 6 |
| Reticulocyte automated CPT 85045 | not published | not published | $3.99 – $10.45 | 6 |
| Reticulocyte direct measurement automated CPT 85046 | not published | not published | $5.57 – $14.59 | 6 |
| Retrograde ejaculation anal CPT 89331 | not published | not published | $19.59 – $51.33 | 6 |
| Reusable nipple prosthesis HCPCS L8032 | not published | not published | $48.49 – $127.04 | 6 |
| Rheumatoid factor qualitative CPT 86430 | not published | not published | $6.14 – $16.09 | 6 |
| Rheumatoid factor quantitative CPT 86431 | not published | not published | $5.67 – $14.86 | 6 |
| Rib gusset (elastic) each HCPCS L1280 | not published | not published | $99.14 – $259.75 | 6 |
| Ring barrier skin cx 1 9/16 adapt HCPCS A4411 | not published | not published | $7.26 – $19.02 | 6 |
| Ring flange plas/leather mol HCPCS L1110 | not published | not published | $296.08 – $775.73 | 6 |
| Ring flange plastic/leather HCPCS L1100 | not published | not published | $203.03 – $531.94 | 6 |
| Ring fx reform 11-13x17mm HCPCS L8610 | not published | not published | $812.14 – $2,127.81 | 6 |
| Ring ostmy barr adapt 48mm HCPCS A4385 | not published | not published | $7.26 – $19.02 | 6 |
| Robt lin-radsurg fractx 2-5 HCPCS G0340 | not published | not published | $17,803.00 – $17,803.00 | 1 |
| Rocker bottom, contact afo HCPCS L2232 | not published | not published | $119.38 – $312.78 | 6 |
| Rotation wrst with cable lock HCPCS L6625 | not published | not published | $868.15 – $2,274.55 | 6 |
| Rotavirus antibody CPT 86759 | not published | not published | $18.23 – $47.76 | 6 |
| Round caliper and plate atta HCPCS L2240 | not published | not published | $96.11 – $251.81 | 6 |
| Rp loclzj tum 2+area 1+d img CPT 78801 | not published | not published | $382.16 – $382.16 | 1 |
| Rp loclzj tum spect w/ct 1 CPT 78830 | not published | not published | $658.61 – $658.61 | 1 |
| Rp loclzj tum spect w/ct 2 CPT 78832 | not published | not published | $1,301.99 – $1,301.99 | 1 |
| Rsv assay w/optic CPT 87807 | not published | not published | $13.10 – $34.32 | 6 |
| Rtm 1st set-up&pt educaj eqp CPT 98975 | not published | not published | $21.33 – $55.88 | 6 |
| Rtm dev sply mscskl 16-30 d CPT 98977 | not published | not published | $50.68 – $132.78 | 6 |
| Rtm dev sply resp sys 16-30d CPT 98976 | not published | not published | $51.34 – $134.51 | 6 |
| Rtm tx mgmt 1st 20 min CPT 98980 | not published | not published | $53.71 – $140.72 | 6 |
| Rtm tx mgmt ea addl 20 min CPT 98981 | not published | not published | $41.19 – $107.92 | 6 |
| Rubella antibody igg CPT 86762 | not published | not published | $14.39 – $37.70 | 6 |
| Rubeola ag if CPT 87283 | not published | not published | $60.80 – $159.30 | 6 |
| Rubeola antibody igg CPT 86765 | not published | not published | $12.88 – $33.75 | 6 |
| Runx1 gene targeted seq alys CPT 81334 | not published | not published | $329.51 – $863.32 | 6 |
| Russell viper venom diluted CPT 85613 | not published | not published | $9.58 – $25.10 | 6 |
| Rx metab gen seq alys pnl 6 CPT 81418 | not published | not published | $917.08 – $2,402.75 | 6 |
| Sach foot, replacement HCPCS L5971 | not published | not published | $278.64 – $730.04 | 6 |
| Salivary gland function exam CPT 78232 | not published | not published | $140.39 – $140.39 | 1 |
| Salivary gland imaging CPT 78230 | not published | not published | $245.22 – $245.22 | 1 |
| Salivary glnd img serial img CPT 78231 | not published | not published | $139.83 – $139.83 | 1 |
| Salmonella antibody CPT 86768 | not published | not published | $13.19 – $34.56 | 6 |
| Sars-cov-2 antb quantitative CPT 86413 | not published | not published | $51.43 – $134.75 | 6 |
| Sarscov coronavirus ag ia CPT 87426 | $65.44 | $65.44 | $35.33 – $92.56 | 6 |
| Sarscov & inf vir a&b ag ia CPT 87428 | not published | not published | $70.29 – $184.16 | 6 |
| Sbrt management CPT 77435 | not published | not published | $1,097.78 – $1,097.78 | 1 |
| Scap thorac prosth tiss shap HCPCS L6570 | not published | not published | $5,358.37 – $14,038.93 | 6 |
| Scr c/v cyto, automated sys HCPCS G0147 | not published | not published | $18.54 – $48.57 | 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.