BAYLOR SCOTT & WHITE MEDICAL CENTER - GRAPEVINE
1650 W. College, Grapevine, TX · Baylor Scott & White Health · · NPI 1073511762
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 |
|---|---|---|---|---|
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $640.93 | $1,068.22 | $35.00 – $248.85 | 24 |
| Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review CPT 88175 | $101.64 | $169.40 | $22.35 – $127.05 | 24 |
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | $102.95 | $171.58 | $17.02 – $128.69 | 24 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | $142.94 | $238.24 | $35.00 – $178.68 | 24 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $179.62 | $299.37 | $10.00 – $224.53 | 24 |
| Cytopathology fna adequacy evaluation each separate additional episode same site CPT 88177 | $109.27 | $182.12 | $17.59 – $154.80 | 18 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | $191.66 | $319.43 | $35.00 – $423.12 | 24 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | $262.49 | $437.49 | $35.00 – $328.12 | 24 |
| Cytopath smear other source CPT 88160 | $85.80 | $143.00 | $21.45 – $107.25 | 24 |
| Cytopath smear other source CPT 88162 | $145.31 | $242.18 | $35.00 – $181.63 | 24 |
| Cytopath smear oth prep screen & interp CPT 88161 | $100.34 | $167.23 | $25.08 – $125.42 | 24 |
| Cytopath tbs c/v manual CPT 88164 | $57.94 | $96.57 | $15.28 – $72.43 | 24 |
| Cytotoxic antibody screening CPT 86807 | $363.33 | $605.55 | $10.00 – $454.16 | 24 |
| Dacarbazine 100 mg intravenous solution HCPCS J9130 | $73.20 | $122.00 | $4.24 – $103.70 | 19 |
| Dactinomycin 0.5 mg intravenous solution HCPCS J9120 | $4,905.37 | $8,175.62 | $320.79 – $6,131.72 | 24 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | $1,205.80 | $2,009.66 | $0.04 – $131.75 | 19 |
| Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln HCPCS J9144 | $18,070.73 | $30,117.88 | $52.28 – $22,588.41 | 24 |
| Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe HCPCS J0881 | $1,410.00 | $2,350.00 | $2.92 – $674.06 | 24 |
| Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution HCPCS J9153 | $18,849.00 | $31,415.00 | $240.67 – $20,343.75 | 24 |
| Daunorubicin 5 mg/ml intravenous solution HCPCS J9150 | $864.30 | $1,440.50 | $27.22 – $544.11 | 19 |
| D&c after delivery 59160 CPT 59160 | $3,441.98 | $5,736.64 | $1,063.52 – $7,744.80 | 24 |
| D&c/diagnostic/therapeutic/non ob 58120 CPT 58120 | $4,150.07 | $6,916.78 | $1,063.52 – $7,744.80 | 24 |
| Dch glucoscan CPT 82948 | $30.85 | $51.41 | $4.23 – $38.56 | 24 |
| Dch pulmonary stress test CPT 94621 | $1,519.72 | $2,532.86 | $285.45 – $1,899.64 | 24 |
| Dch validity tests CPT 81002 | $35.80 | $59.67 | $2.92 – $44.75 | 24 |
| Dcm pq ndl dsk sgl/mlt lv lmbr w/guide CPT 62287 | $5,321.73 | $8,869.55 | $659.94 – $6,652.16 | 24 |
| Deamidated gliadin antibody iga CPT 86258 | $131.24 | $218.74 | $10.00 – $164.06 | 24 |
| Debrid ecz/inf skin up tp 10% body 11000 CPT 11000 | $602.45 | $1,004.08 | $28.98 – $1,555.84 | 24 |
| Debridement (>20 cm) charge pt CPT 97598 | $414.23 | $690.39 | $35.40 – $586.83 | 19 |
| Debridement bone <= 20 sq cm CPT 11044 | $2,951.16 | $4,918.60 | $566.62 – $4,016.35 | 24 |
| Debridement/bone/20 sq cm or less 11046 CPT 11046 | $927.37 | $1,545.61 | $231.84 – $1,313.77 | 18 |
| Debridement/bone/ea add 20 sq cm 11047 CPT 11047 | $1,738.00 | $2,896.67 | $434.50 – $2,462.17 | 18 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | $1,011.76 | $1,686.27 | $171.51 – $1,264.70 | 24 |
| Debride nail1-5 11720 CPT 11720 | $186.88 | $311.47 | $46.72 – $233.60 | 24 |
| Debride nail6 or more 11721 CPT 11721 | $200.21 | $333.69 | $50.05 – $250.27 | 24 |
| Debride/rmv fb/open fx/skin/sq/musc11011 CPT 11011 | not published | not published | $257.60 – $4,063.00 | 16 |
| Debride skin bone at fx site CPT 11012 | $2,174.51 | $3,624.18 | $815.20 – $7,039.11 | 24 |
| Debride skn/sq/musc/abd wall 11004 CPT 11004 | not published | not published | $1,016.52 – $7,038.00 | 3 |
| Debride skn/sq t/m/f necro infctj abdl wall 11005 CPT 11005 | $2,850.11 | $4,750.19 | $712.53 – $4,037.66 | 18 |
| Debride/subq tissue/ea add 20sq cm 11045 CPT 11045 | $914.76 | $1,524.60 | $228.69 – $1,295.91 | 18 |
| Debrid mastoidectomy cavity simple 69220 CPT 69220 | not published | not published | $111.00 – $495.95 | 16 |
| Debrid/rmv fgn bdy/open fx/skin/sq 11010 CPT 11010 | $1,728.86 | $2,881.43 | $257.60 – $2,161.07 | 24 |
| Debr musc/fascia 20sq cm/< 11043 CPT 11043 | $1,353.12 | $2,255.20 | $262.63 – $1,691.40 | 24 |
| Decalcification CPT 88311 | $88.31 | $147.19 | $10.00 – $125.11 | 18 |
| Decitabine 50 mg intravenous solution HCPCS J0894 | $3,109.80 | $5,183.00 | $1.10 – $4,405.55 | 19 |
| Declotting thrombolytic agent implanted vas access device 36 CPT 36593 | $635.93 | $1,059.88 | $26.30 – $838.97 | 24 |
| Decomp fasct leg ant+/lat+pst cmprt 27602 CPT 27602 | $7,088.32 | $11,813.87 | $1,088.27 – $8,860.40 | 24 |
| Decompression of lower leg CPT 27600 | $3,408.30 | $5,680.50 | $1,088.27 – $8,018.48 | 24 |
| Decompression of tibia nerve CPT 28035 | not published | not published | $659.94 – $6,703.00 | 17 |
| Deep muscle biopsy 20205 CPT 20205 | $3,111.06 | $5,185.10 | $815.20 – $7,039.11 | 24 |
| Deferoxamine 500 mg solution for injection HCPCS J0895 | $34.05 | $56.75 | $8.51 – $48.24 | 19 |
| Degarelix 120 mg subcutaneous solution HCPCS J9155 | $1,318.82 | $2,198.03 | $4.24 – $1,648.52 | 24 |
| Delayed breast prosthesis 19342 CPT 19342 | not published | not published | $2,281.73 – $23,352.21 | 17 |
| Delay flap eye/nos/ear/lip CPT 15630 | not published | not published | $709.01 – $6,093.00 | 17 |
| Delay flap fccnaxghf 15620 CPT 15620 | not published | not published | $709.01 – $6,703.00 | 17 |
| Delivery of placenta 59414 CPT 59414 | $3,135.14 | $5,225.23 | $1,063.52 – $7,744.80 | 24 |
| Delivery transcath fxtn dvc to endogrft w/s&i CPT 34712 | $8,127.00 | $13,545.00 | $1,208.99 – $11,513.25 | 16 |
| Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 | $235.79 | $392.99 | $58.95 – $528.37 | 24 |
| Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution HCPCS J0897 | $5,913.85 | $9,856.41 | $28.03 – $4,018.77 | 24 |
| Dentoalveolar/drain abs/cyst/hema 41800 CPT 41800 | $488.60 | $814.34 | $122.15 – $610.75 | 24 |
| Derma-fat-fascia graft 15770 CPT 15770 | not published | not published | $1,457.62 – $8,887.48 | 17 |
| Dermapure 1 square cm HCPCS Q4152 | $266.63 | $444.39 | $29.02 – $269.22 | 23 |
| Derm autograft face/nck/hf/g CPT 15135 | not published | not published | $1,457.62 – $8,887.48 | 17 |
| Descend thora aorta rpr/lt sub art 33880 CPT 33880 | $8,684.65 | $14,474.42 | $2,171.16 – $12,303.26 | 16 |
| Design mlc device for imrt CPT 77338 | $1,980.92 | $3,301.54 | $357.92 – $2,476.16 | 24 |
| Desmopressin 4 mcg/ml injection solution HCPCS J2597 | $1,071.36 | $1,785.60 | $3.75 – $52.43 | 19 |
| Desoxycorticosterone CPT 82633 | $202.78 | $337.97 | $10.00 – $253.48 | 24 |
| Des thora aorta/ea add prox prosth 33884 CPT 33884 | $2,025.15 | $3,375.25 | $506.29 – $2,868.96 | 17 |
| Des thora aorta rpr without left sub art 33881 CPT 33881 | $2,591.05 | $4,318.41 | $647.76 – $7,038.00 | 16 |
| Des thor aorta/prox ext prosth/ini 33883 CPT 33883 | $1,831.72 | $3,052.86 | $457.93 – $2,594.93 | 17 |
| Destroy cervthor facet jnt 64633 CPT 64633 | $2,520.05 | $4,200.08 | $659.94 – $4,783.04 | 24 |
| Destroy cth facet jnt addl 64634 CPT 64634 | $1,573.93 | $2,623.22 | $393.48 – $2,229.74 | 18 |
| Destroy premlg lesns;1st lesn 17000 CPT 17000 | $159.78 | $266.30 | $39.95 – $495.95 | 24 |
| Destruct cut vasl lesions <10cm 17106 CPT 17106 | $406.42 | $677.36 | $143.08 – $987.79 | 24 |
| Destruction 2-14 lesions 17003 CPT 17003 | $52.72 | $87.86 | $13.18 – $74.68 | 14 |
| Destruction anal lesion(s) CPT 46924 | not published | not published | $939.93 – $6,955.62 | 17 |
| Destruction benign lesions < 14 lesions CPT 17110 | $210.98 | $351.64 | $52.75 – $495.95 | 24 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | $1,313.66 | $2,189.43 | $328.41 – $1,861.02 | 18 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $3,101.88 | $5,169.80 | $659.94 – $4,783.04 | 24 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | not published | not published | $709.01 – $4,517.58 | 17 |
| Destruction vag lesions simple 57061 CPT 57061 | $3,504.00 | $5,840.00 | $98.83 – $7,744.80 | 24 |
| Detect agent nos dna dir CPT 87797 | $186.00 | $310.00 | $10.00 – $149.54 | 24 |
| Determination venous press CPT 93770 | $246.34 | $410.57 | $25.45 – $348.98 | 18 |
| Device ablt adv novasure HCPCS C1886 | $9,177.30 | $15,295.50 | $241.94 – $1,371.02 | 18 |
| Device hemospray 7frx220cm endo hemostat min access HCPCS C1052 | $5,098.50 | $8,497.50 | $18.70 – $7,222.88 | 18 |
| Device intraute mirena HCPCS J7298 | $2,082.22 | $3,470.37 | $520.56 – $2,949.81 | 18 |
| Device tiss remov myosure reach HCPCS C1782 | $2,541.00 | $4,235.00 | $169.78 – $962.12 | 18 |
| Dev interrog remote 1/2/mlt CPT 93295 | $127.80 | $213.00 | $31.95 – $181.05 | 18 |
| Dev tst admin phys/qhp ea addl 30 min CPT 96113 | $203.19 | $338.65 | $50.80 – $287.85 | 18 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $220.43 | $367.38 | $31.74 – $275.54 | 24 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $85.86 | $143.10 | $0.03 – $0.29 | 19 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $27.00 | $45.00 | $0.12 – $9.95 | 19 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | $1,268.38 | $2,113.97 | $47.25 – $792.72 | 24 |
| Dextran 40 infusion HCPCS J7100 | $151.20 | $252.00 | $37.80 – $214.20 | 18 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $28.80 | $48.00 | $1.12 – $6.38 | 19 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $28.80 | $48.00 | $6.30 – $35.70 | 18 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $31.32 | $52.20 | $2.06 – $11.98 | 19 |
| Dextrose 5 % IV bolus HCPCS J7070 | $28.80 | $48.00 | $3.38 – $21.16 | 19 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $157.70 | $262.84 | $10.00 – $197.13 | 24 |
| Diabetes (HbA1c) Test CPT 83036 | $111.51 | $185.85 | $8.16 – $115.11 | 24 |
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.