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 |
|---|---|---|---|---|
| Scr c/v cyto,autosys and md HCPCS G0141 | not published | not published | $38.82 – $38.82 | 1 |
| Scr c/v cyto, autosys, rescr HCPCS G0148 | not published | not published | $31.94 – $83.68 | 6 |
| Scr c/v cyto,thinlayer,rescr HCPCS G0144 | not published | not published | $43.97 – $115.20 | 6 |
| Scr c/v cyto,thinlayer,rescr HCPCS G0145 | not published | not published | $26.49 – $69.40 | 6 |
| Scr c/v cyto,thinlayer,rescr HCPCS G0143 | not published | not published | $27.05 – $70.87 | 6 |
| Screen cerv/vag thin layer HCPCS G0123 | not published | not published | $20.26 – $53.08 | 6 |
| Screen c/v thin layer by md HCPCS G0124 | not published | not published | $38.82 – $38.82 | 1 |
| Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations HCPCS G0328 | not published | not published | $18.05 – $47.29 | 6 |
| Screening hepatitis b non-obstetric high risk HCPCS G0499 | not published | not published | $28.27 – $74.07 | 6 |
| Screening hepatitis c antibody high risk HCPCS G0472 | not published | not published | $46.35 – $121.44 | 6 |
| Screening HIV antigen/antibody combination assay HCPCS G0475 | not published | not published | $24.08 – $63.09 | 6 |
| Screening Mammogram CPT 77067 | not published | not published | $89.87 – $235.46 | 6 |
| Screening pap smear by phys HCPCS P3001 | not published | not published | $29.11 – $29.11 | 1 |
| Screening prostate cancer PSA HCPCS G0103 | not published | not published | $19.31 – $50.59 | 6 |
| Screen pap by tech w md supv HCPCS P3000 | not published | not published | $18.54 – $48.57 | 6 |
| Sedimentation rate erythrocyte automated CPT 85652 | $206.95 | $206.95 | $2.70 – $7.07 | 6 |
| Self-adher band w>=3" <5"/yd HCPCS A6454 | not published | not published | $1.12 – $2.93 | 6 |
| Semen analysis HCPCS G0027 | not published | not published | $6.50 – $17.03 | 6 |
| Semen analysis presence/motility CPT 89321 | not published | not published | $12.05 – $31.57 | 6 |
| Semen analysis w/count CPT 89310 | not published | not published | $8.61 – $22.56 | 6 |
| Sept9 promoter methylation analysis CPT 81327 | not published | not published | $192.00 – $503.04 | 6 |
| Serpina1 gene CPT 81332 | not published | not published | $43.65 – $114.36 | 6 |
| Sertraline (zoloft) - sendout CPT 80332 | not published | not published | $0.02 – $0.02 | 1 |
| Set radiation therapy field CPT 77280 | not published | not published | $410.65 – $410.65 | 1 |
| Set radiation therapy field CPT 77285 | not published | not published | $689.33 – $689.33 | 1 |
| Set radiation therapy field CPT 77290 | not published | not published | $668.34 – $668.34 | 1 |
| Sewhfo airplane without jnts cf HCPCS L3976 | not published | not published | $1,889.14 – $4,949.55 | 6 |
| Sewhfo airplane w/jnt(s) cf HCPCS L3978 | not published | not published | $2,230.51 – $5,843.94 | 6 |
| Sewhfo cap desgn w/jnt(s) cf HCPCS L3977 | not published | not published | $2,117.21 – $5,547.09 | 6 |
| Sewhfo cap design without jnt cf HCPCS L3975 | not published | not published | $1,889.14 – $4,949.55 | 6 |
| Sewho airplane without jnts cf HCPCS L3967 | not published | not published | $2,230.51 – $5,843.94 | 6 |
| Sewho airplane w/jnt(s) cf HCPCS L3973 | not published | not published | $2,230.51 – $5,843.94 | 6 |
| Sewho cap design without jnts cf HCPCS L3961 | not published | not published | $1,889.14 – $4,949.55 | 6 |
| Sewho cap design w/jnt(s) cf HCPCS L3971 | not published | not published | $2,117.21 – $5,547.09 | 6 |
| Sewho erbs palsey design abd HCPCS L3962 | not published | not published | $806.80 – $2,113.82 | 6 |
| Sex chromatin identification CPT 88130 | not published | not published | $17.98 – $47.11 | 6 |
| Sex chromatin identification CPT 88140 | not published | not published | $7.99 – $20.93 | 6 |
| Sf3b1 gene common variants CPT 81347 | not published | not published | $193.25 – $506.31 | 6 |
| Sheath above knee HCPCS L8410 | not published | not published | $28.16 – $73.78 | 6 |
| Sheath below knee HCPCS L8400 | not published | not published | $19.27 – $50.49 | 6 |
| Sheath upper limb HCPCS L8415 | not published | not published | $28.64 – $75.04 | 6 |
| Shigella antibody CPT 86771 | not published | not published | $24.48 – $64.14 | 6 |
| Shlder disart int lock elbow HCPCS L6300 | not published | not published | $4,870.31 – $12,760.21 | 6 |
| Shldr disar prosth tiss shap HCPCS L6550 | not published | not published | $4,668.36 – $12,231.10 | 6 |
| Shldr disartic myoelectronic HCPCS L6965 | not published | not published | $23,134.40 – $60,612.13 | 6 |
| Shoe clubfoot wedge HCPCS L3380 | not published | not published | $61.28 – $160.55 | 6 |
| Shoe dennis browne splint bo HCPCS L3640 | not published | not published | $53.41 – $139.93 | 6 |
| Shoe heel new leather standa HCPCS L3455 | not published | not published | $50.31 – $131.81 | 6 |
| Shoe heel new rubber standar HCPCS L3460 | not published | not published | $42.41 – $111.11 | 6 |
| Shoe heel pad & depress for HCPCS L3480 | not published | not published | $76.99 – $201.71 | 6 |
| Shoe heel sach cushion type HCPCS L3450 | not published | not published | $130.40 – $341.65 | 6 |
| Shoe heel thomas extend to b HCPCS L3470 | not published | not published | $76.99 – $201.71 | 6 |
| Shoe heel thomas with wedge HCPCS L3465 | not published | not published | $72.28 – $189.37 | 6 |
| Shoe lift elev heel/sole neo HCPCS L3310 | not published | not published | $100.56 – $263.47 | 6 |
| Shoe metatarsal bar between HCPCS L3410 | not published | not published | $114.74 – $300.62 | 6 |
| Shoe metatarsal bar wedge ro HCPCS L3400 | not published | not published | $50.31 – $131.81 | 6 |
| Shoe outflare wedge HCPCS L3390 | not published | not published | $61.28 – $160.55 | 6 |
| Shoe sole wedge between sole HCPCS L3370 | not published | not published | $61.28 – $160.55 | 6 |
| Shoe sole wedge outside sole HCPCS L3360 | not published | not published | $44.00 – $115.28 | 6 |
| Shoe wedge sach HCPCS L3340 | not published | not published | $105.25 – $275.75 | 6 |
| Sho heel count plast reinfor HCPCS L3430 | not published | not published | $197.99 – $518.73 | 6 |
| Sho insert w arch toe filler HCPCS L5000 | not published | not published | $824.75 – $2,160.85 | 6 |
| Sho lift taper to metatarsal HCPCS L3300 | not published | not published | $64.41 – $168.75 | 6 |
| Shoulder abduction joint pai HCPCS L6640 | not published | not published | $441.57 – $1,156.91 | 6 |
| Shoulder flexion-abduction j HCPCS L6645 | not published | not published | $493.10 – $1,291.92 | 6 |
| Shoulder harness HCPCS L5699 | not published | not published | $228.26 – $598.04 | 6 |
| Shoulder lock actuator HCPCS L6647 | not published | not published | $642.79 – $1,684.11 | 6 |
| Shoulder MRI (with and without contrast) CPT 73223 | not published | not published | $761.00 – $761.00 | 1 |
| Shoulder MRI (with contrast) CPT 73222 | not published | not published | $761.00 – $761.00 | 1 |
| Shoulder MRI (without contrast) CPT 73221 | not published | not published | $761.00 – $761.00 | 1 |
| Shoulder universal joint HCPCS L6650 | not published | not published | $517.73 – $1,356.45 | 6 |
| Shoulder X-ray CPT 73030 | not published | not published | $42.57 – $42.57 | 1 |
| Shrinker prosth above knee HCPCS L8460 | not published | not published | $94.08 – $246.49 | 6 |
| Shrinker prosth below knee HCPCS L8440 | not published | not published | $54.07 – $141.66 | 6 |
| Shrinker upper limb HCPCS L8465 | not published | not published | $67.04 – $175.64 | 6 |
| Shuntogram nonvascular supervision & interpretation CPT 75809 | not published | not published | $100.04 – $100.04 | 1 |
| Sialidase enzyme assay CPT 87905 | not published | not published | $12.22 – $32.02 | 6 |
| Sialography s&i CPT 70390 | not published | not published | $172.75 – $172.75 | 1 |
| Sickling rbc CPT 85660 | not published | not published | $5.51 – $14.44 | 6 |
| Silicon gel insert w/wo lock HCPCS L6692 | not published | not published | $871.10 – $2,282.28 | 6 |
| Single pivot hinge pair HCPCS L6605 | not published | not published | $302.33 – $792.10 | 6 |
| Sinus CT scan (with and without contrast) CPT 70488 | not published | not published | $584.00 – $584.00 | 1 |
| Sinus CT scan (with contrast) CPT 70487 | not published | not published | $584.00 – $584.00 | 1 |
| Sinus CT scan (without contrast) CPT 70486 | not published | not published | $584.00 – $584.00 | 1 |
| Sinus/juglr venogram s&i CPT 75860 | not published | not published | $122.60 – $122.60 | 1 |
| Sio flex pelvisacral custom HCPCS L0622 | not published | not published | $296.87 – $777.80 | 6 |
| Sio rig pnl pelv/sac pre ots HCPCS L0623 | not published | not published | $129.31 – $338.79 | 6 |
| Six volt bat otto bock/eq ea HCPCS L7360 | not published | not published | $294.78 – $772.32 | 6 |
| Skeletal muscle relaxant 1/2 CPT 80369 | not published | not published | $0.02 – $0.02 | 1 |
| Skel musc relaxant 3 or more CPT 80370 | not published | not published | $0.02 – $0.02 | 1 |
| Skin barrier with flange HCPCS A4373 | not published | not published | $8.94 – $23.42 | 6 |
| Skin test unlisted antigen ea CPT 86486 | not published | not published | $7.91 – $7.91 | 1 |
| Slco1b1 gene com variants CPT 81328 | not published | not published | $174.81 – $458.00 | 6 |
| Sleep study attended CPT 95807 | not published | not published | $752.37 – $752.37 | 1 |
| Sleep Study (Polysomnography) CPT 95810 | not published | not published | $1,153.47 – $1,153.47 | 1 |
| Sleep study unattended CPT 95806 | not published | not published | $111.09 – $111.09 | 1 |
| Sleeve fing rolyan med HCPCS L3933 | not published | not published | $239.91 – $628.56 | 6 |
| Sling arm deluxe w/pad xs HCPCS A4565 | not published | not published | $10.98 – $28.77 | 6 |
| Sling pelv split sam med HCPCS L0621 | not published | not published | $72.14 – $189.01 | 6 |
| Small animal inoculation CPT 87003 | not published | not published | $16.84 – $44.12 | 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.