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 |
|---|---|---|---|---|
| Sulfonylurea screen qn-sendout CPT 80377 | not published | not published | $0.02 – $0.02 | 1 |
| Sup/ext non-ins inf pump syr HCPCS K0552 | not published | not published | $3.47 – $9.09 | 6 |
| Supp non-insulin inf cath/wk HCPCS A4221 | not published | not published | $25.87 – $67.78 | 6 |
| Support clav 29.6-40.5in med HCPCS L3650 | not published | not published | $73.08 – $191.47 | 6 |
| Surgical pathology level 1 gross examination only CPT 88300 | not published | not published | $14.25 – $14.25 | 1 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | not published | not published | $32.75 – $32.75 | 1 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | not published | not published | $39.98 – $39.98 | 1 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | not published | not published | $44.94 – $44.94 | 1 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | not published | not published | $271.04 – $271.04 | 1 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | not published | not published | $386.67 – $386.67 | 1 |
| Susceptibility agar dilution per agent CPT 87181 | $53.75 | $53.75 | $4.75 – $12.45 | 6 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $50.07 | $50.07 | $4.75 – $12.45 | 6 |
| Susceptibility mic per plate CPT 87186 | $146.66 | $146.66 | $8.65 – $22.66 | 6 |
| Suscept studies macrobroth dilution ea CPT 87188 | not published | not published | $6.64 – $17.40 | 6 |
| Suspension sleeve lower ext HCPCS L2397 | not published | not published | $134.68 – $352.86 | 6 |
| Svc venogram s&i CPT 75827 | not published | not published | $113.00 – $113.00 | 1 |
| Sweat collection by iontophoresis CPT 89230 | not published | not published | $2.95 – $2.95 | 1 |
| Symes ankle without (sach) foot HCPCS L5703 | not published | not published | $3,262.87 – $8,548.72 | 6 |
| Symes met fr leath socket ar HCPCS L5060 | not published | not published | $4,001.69 – $10,484.43 | 6 |
| Symes type medial opening so HCPCS L5636 | not published | not published | $311.94 – $817.28 | 6 |
| Symes type poster opening so HCPCS L5634 | not published | not published | $372.40 – $975.69 | 6 |
| Symes type ptb brim design s HCPCS L5632 | not published | not published | $271.83 – $712.19 | 6 |
| Syme typ expandabl wall sckt HCPCS L5630 | not published | not published | $633.26 – $1,659.14 | 6 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $109.59 | $109.59 | $4.40 – $11.53 | 6 |
| T3 (triiodothyronine) free CPT 84481 | $236.01 | $236.01 | $16.94 – $44.38 | 6 |
| T3 (triiodothyronine) total CPT 84480 | $1,069.16 | $1,069.16 | $14.18 – $37.15 | 6 |
| T4 (thyroxine) free CPT 84439 | $429.38 | $429.38 | $9.02 – $23.63 | 6 |
| T4 (thyroxine) total CPT 84436 | $206.73 | $206.73 | $6.87 – $18.00 | 6 |
| Tacrolimus therapeutic drug level CPT 80197 | not published | not published | $13.73 – $35.97 | 6 |
| Tape plstc 1inx5yd hosp tb pk HCPCS A4452 | not published | not published | $0.50 – $1.31 | 6 |
| Target gsa panel hmtlmph neop CPT 81450 | not published | not published | $759.53 – $1,989.97 | 6 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | not published | not published | $2,919.60 – $7,649.35 | 6 |
| Target gsa panel organ neop CPT 81445 | not published | not published | $597.91 – $1,566.52 | 6 |
| Tbp gene detc abnor alleles CPT 81344 | not published | not published | $137.00 – $358.94 | 6 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | not published | not published | $100.00 – $262.00 | 6 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | not published | not published | $61.98 – $162.39 | 6 |
| Tc-99m apcitide diag HCPCS A9504 | not published | not published | $1,024.00 – $1,024.00 | 1 |
| Tc-99m arcitumomab HCPCS A9568 | not published | not published | $2,662.40 – $2,662.40 | 1 |
| Tc-99m bicisate HCPCS A9557 | not published | not published | $9,010.36 – $9,010.36 | 1 |
| Tc-99m depreotide HCPCS A9536 | not published | not published | $2,867.20 – $2,867.20 | 1 |
| Tc-99m disofenin HCPCS A9510 | not published | not published | $172.03 – $172.03 | 1 |
| Tc-99m exame autol wbc diag per dose HCPCS A9569 | not published | not published | $4,212.25 – $4,212.25 | 1 |
| Tc-99m exametazime diag HCPCS A9521 | not published | not published | $4,212.25 – $4,212.25 | 1 |
| Tc-99m fanolesomab diag HCPCS A9566 | not published | not published | $529.20 – $529.20 | 1 |
| Tc-99m gluceptate HCPCS A9550 | not published | not published | $52.04 – $52.04 | 1 |
| Tc-99m labeled rbc HCPCS A9560 | not published | not published | $229.53 – $229.53 | 1 |
| Tc-99m maa HCPCS A9540 | not published | not published | $73.73 – $73.73 | 1 |
| Tc-99m mebrofenin HCPCS A9537 | not published | not published | $135.94 – $135.94 | 1 |
| Tc-99m medronate HCPCS A9503 | not published | not published | $31.95 – $31.95 | 1 |
| Tc-99m mertiatide HCPCS A9562 | not published | not published | $1,527.04 – $1,527.04 | 1 |
| Tc-99m non-heu per study dose HCPCS Q9969 | not published | not published | $7.53 – $7.53 | 1 |
| Tc-99m oxidronate HCPCS A9561 | not published | not published | $108.13 – $108.13 | 1 |
| Tc-99m pentetate dtpa HCPCS A9539 | not published | not published | $77.00 – $77.00 | 1 |
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | not published | not published | $42.96 – $42.96 | 1 |
| Tc-99m pertechnetate per mci HCPCS A9512 | not published | not published | $4.15 – $4.15 | 1 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | not published | not published | $157.41 – $157.41 | 1 |
| Tc-99m sestamibi p study dose HCPCS A9500 | not published | not published | $262.35 – $262.35 | 1 |
| Tc-99m succimer (dmsa) HCPCS A9551 | not published | not published | $1,473.13 – $1,473.13 | 1 |
| Tc-99m sulfur colloid HCPCS A9541 | not published | not published | $657.08 – $657.08 | 1 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | not published | not published | $209.56 – $209.56 | 1 |
| Tc-99m tilmanocept diag HCPCS A9520 | not published | not published | $1,625.88 – $1,625.88 | 1 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | not published | not published | $46.98 – $123.09 | 6 |
| T cells absolute cd 4 count CPT 86361 | not published | not published | $26.78 – $70.16 | 6 |
| T cells total count CPT 86359 | not published | not published | $37.73 – $98.85 | 6 |
| Tcranial magn stim tx deli CPT 90868 | not published | not published | $285.00 – $285.00 | 1 |
| Tcranial magn stim tx plan CPT 90867 | not published | not published | $478.00 – $478.00 | 1 |
| Tcran magn stim redetemine CPT 90869 | not published | not published | $565.00 – $565.00 | 1 |
| Teflon or equal cable lining HCPCS L6665 | not published | not published | $75.17 – $196.95 | 6 |
| Telethx isodose plan cplx CPT 77307 | not published | not published | $231.65 – $231.65 | 1 |
| Telethx isodose plan simple CPT 77306 | not published | not published | $127.82 – $127.82 | 1 |
| Tension based scoliosis orth HCPCS L1005 | not published | not published | $3,954.38 – $10,360.48 | 6 |
| Tens suppl 2 lead per month HCPCS A4595 | not published | not published | $12.84 – $33.64 | 6 |
| Term dev auto grasp feature HCPCS L6881 | not published | not published | $5,060.90 – $13,259.56 | 6 |
| Term device, multi art digit HCPCS L6715 | not published | not published | $3,908.27 – $10,239.67 | 6 |
| Term dev mech hand vol close HCPCS L6709 | not published | not published | $1,728.38 – $4,528.36 | 6 |
| Term dev mech hand vol open HCPCS L6708 | not published | not published | $1,178.02 – $3,086.41 | 6 |
| Term dev mech hook vol close HCPCS L6707 | not published | not published | $1,752.80 – $4,592.34 | 6 |
| Term dev mech hook vol open HCPCS L6706 | not published | not published | $492.59 – $1,290.59 | 6 |
| Term dev modifier wrist unit HCPCS L6805 | not published | not published | $520.97 – $1,364.94 | 6 |
| Term dev, passive hand mitt HCPCS L6703 | not published | not published | $404.88 – $1,060.79 | 6 |
| Term dev precision pinch dev HCPCS L6810 | not published | not published | $304.48 – $797.74 | 6 |
| Term dev, sport/rec/work att HCPCS L6704 | not published | not published | $949.50 – $2,487.69 | 6 |
| Tert gene targeted seq alys CPT 81345 | not published | not published | $185.20 – $485.22 | 6 |
| Test for chlorohydrocarbons CPT 82441 | not published | not published | $6.01 – $15.75 | 6 |
| Test for porphobilinogen CPT 84106 | not published | not published | $5.82 – $15.25 | 6 |
| Test for urine cystines CPT 82615 | not published | not published | $9.55 – $25.02 | 6 |
| Testicular imaging w/vasc flow CPT 78761 | not published | not published | $281.86 – $281.86 | 1 |
| Testosterone response panel CPT 80414 | not published | not published | $51.64 – $135.30 | 6 |
| Test pathogen(s) for platelets reference HCPCS P9100 | not published | not published | $106.81 – $106.81 | 1 |
| Test sock elbw disart/above HCPCS L6682 | not published | not published | $370.84 – $971.60 | 6 |
| Test socket above knee HCPCS L5624 | not published | not published | $593.44 – $1,554.81 | 6 |
| Test socket below knee HCPCS L5620 | not published | not published | $453.81 – $1,188.98 | 6 |
| Test socket hemipelvectomy HCPCS L5628 | not published | not published | $703.32 – $1,842.70 | 6 |
| Test socket hip disarticulat HCPCS L5626 | not published | not published | $651.69 – $1,707.43 | 6 |
| Test socket knee disarticula HCPCS L5622 | not published | not published | $591.76 – $1,550.41 | 6 |
| Test socket shldr disart/tho HCPCS L6684 | not published | not published | $426.74 – $1,118.06 | 6 |
| Test socket symes HCPCS L5618 | not published | not published | $369.85 – $969.01 | 6 |
| Test sock wrist disart/bel e HCPCS L6680 | not published | not published | $378.71 – $992.22 | 6 |
| Test urine for lactose CPT 83633 | not published | not published | $11.25 – $29.48 | 6 |
| Test urine for porphyrins CPT 84119 | not published | not published | $13.36 – $35.00 | 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.