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 |
|---|---|---|---|---|
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $3,915.55 | $6,525.92 | $356.71 – $4,894.44 | 24 |
| Ghs windowing of cast CPT 29730 | $235.37 | $392.28 | $27.69 – $390.34 | 24 |
| Gi inhouse confirmation CPT 87045 | $153.28 | $255.47 | $7.93 – $191.60 | 24 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $2,418.92 | $4,031.53 | $732.90 – $3,023.65 | 22 |
| Gi trc img intral esophagus CPT 91111 | $1,897.82 | $3,163.03 | $866.99 – $2,372.27 | 22 |
| Gjb2 gene full sequence CPT 81252 | $628.20 | $1,047.00 | $10.00 – $785.25 | 24 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $682.24 | $1,137.06 | $115.83 – $579.15 | 24 |
| Glucagon plasma - sendout CPT 82943 | $93.45 | $155.75 | $10.00 – $116.81 | 24 |
| Glucose 1 hr post dose CPT 82950 | $68.98 | $114.97 | $3.99 – $86.23 | 24 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | $67.13 | $111.88 | $5.08 – $83.91 | 24 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $33.96 | $56.60 | $3.12 – $42.45 | 24 |
| Glucose blood quantitative CPT 82947 | $59.87 | $99.79 | $3.30 – $64.69 | 24 |
| Glucose body fluid CPT 82945 | $76.34 | $127.23 | $3.30 – $67.11 | 24 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $151.93 | $253.21 | $10.00 – $189.91 | 24 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $45.82 | $76.36 | $3.29 – $57.27 | 24 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $49.20 | $82.00 | $0.40 – $16.66 | 19 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $3,598.55 | $5,997.58 | $10.73 – $4,498.19 | 24 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $162.51 | $270.85 | $10.00 – $44.59 | 24 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $316.50 | $527.50 | $10.00 – $44.45 | 24 |
| Goniotomy CPT 65820 | $3,945.62 | $6,576.03 | $1,533.49 – $10,072.14 | 24 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $5,010.53 | $8,350.89 | $446.77 – $2,531.69 | 19 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $4,733.71 | $7,889.52 | $25.48 – $269.22 | 23 |
| Graft axiofill 1000mg HCPCS J3590 | $3,456.79 | $5,761.31 | $0.01 – $0.06 | 18 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $388.13 | $646.89 | $37.48 – $269.22 | 23 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $27,603.28 | $46,005.47 | $10.85 – $269.22 | 23 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $20,782.10 | $34,636.83 | $100.87 – $537.98 | 17 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $50,985.00 | $84,975.00 | $10.57 – $56.38 | 17 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $1,315.71 | $2,192.85 | $76.02 – $380.09 | 23 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $765.06 | $1,275.10 | $46.95 – $269.22 | 23 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $7,021.66 | $11,702.76 | $24.43 – $269.22 | 23 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $4,742.40 | $7,904.00 | $4.56 – $269.22 | 23 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $800.41 | $1,334.02 | $58.73 – $293.67 | 23 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $50,985.00 | $84,975.00 | $24.18 – $128.98 | 17 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $3,670.92 | $6,118.20 | $3.88 – $20.71 | 17 |
| Granulocyte pheresis ea unit HCPCS P9050 | $3,781.95 | $6,303.25 | $945.49 – $5,357.76 | 18 |
| Great toe with reduction 28495 CPT 28495 | $605.99 | $1,009.99 | $85.32 – $757.49 | 24 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | not published | not published | $709.01 – $10,795.00 | 16 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | $5,102.99 | $8,504.99 | $1,457.62 – $8,887.48 | 24 |
| Grfg autol fat lipo ea addl CPT 15772 | not published | not published | $1,896.00 – $1,896.00 | 1 |
| Grfg autol soft tiss dir exc CPT 15769 | not published | not published | $1,457.62 – $10,795.00 | 16 |
| Group health education CPT 99078 | $50.11 | $83.51 | $12.53 – $70.98 | 18 |
| Group mnt 2 or more 30 mins HCPCS G0271 | $66.55 | $110.92 | $16.64 – $94.28 | 18 |
| Growth stimulation gene 2 CPT 83006 | $270.00 | $450.00 | $10.00 – $181.44 | 24 |
| Gstrct prtl dstl w/roux-en-y rcnstj 43633 CPT 43633 | not published | not published | $2,546.00 – $7,038.00 | 3 |
| Gstrst open wo constj tube CPT 43830 | $4,908.49 | $8,180.82 | $1,227.12 – $7,038.00 | 22 |
| G-tube reposition CPT 43761 | $1,291.62 | $2,152.70 | $110.15 – $1,614.53 | 24 |
| Gu dilat ureter/urethra s&i CPT 74485 | $1,525.20 | $2,542.00 | $119.63 – $5,045.72 | 24 |
| Guided cath fluid drainage 10030 CPT 10030 | $2,270.09 | $3,783.48 | $111.00 – $2,837.61 | 24 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $23,453.10 | $39,088.50 | $0.00 – $0.01 | 18 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $2,541.00 | $4,235.00 | $0.00 – $0.01 | 18 |
| Guid loc target vol rad tx CPT 77387 | $620.91 | $1,034.85 | $155.23 – $879.62 | 18 |
| Gw stiffened micro access kit HCPCS C1894 | $9,177.30 | $15,295.50 | $0.00 – $0.01 | 18 |
| Gynecomastia (males) 19300 CPT 19300 | not published | not published | $963.66 – $9,442.65 | 17 |
| Halo cervical into body jack HCPCS L0820 | $3,051.31 | $5,085.52 | $762.83 – $4,068.42 | 17 |
| Halo cervical into jckt vest HCPCS L0810 | $3,617.20 | $6,028.67 | $904.30 – $4,822.94 | 17 |
| Halo cerv into milwaukee typ HCPCS L0830 | $5,529.64 | $9,216.06 | $1,382.41 – $7,372.85 | 17 |
| Haloperidol decanoate 50 mg/ml intramuscular solution HCPCS J1631 | $139.00 | $231.66 | $3.60 – $20.40 | 19 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $74.29 | $123.81 | $0.79 – $4.49 | 19 |
| Handle/convey/speciman/office-lab 99000 CPT 99000 | $30.36 | $50.60 | $7.59 – $43.01 | 18 |
| Handpiece aquabeam hp2000 HCPCS C2596 | $6,628.05 | $11,046.75 | $1,657.01 – $9,389.74 | 18 |
| Hands-On Manual Therapy (each 15 minutes) CPT 97140 | $136.53 | $227.55 | $34.13 – $193.42 | 19 |
| Hand tendon reconstruction CPT 26502 | not published | not published | $1,088.27 – $8,018.48 | 17 |
| Hand X-ray CPT 73130 | $317.78 | $529.64 | $37.43 – $397.23 | 24 |
| Hand X-ray (2 views, both hands) CPT 73120 | $318.00 | $530.00 | $31.74 – $397.50 | 24 |
| Haptoglobin quantitative CPT 83010 | $119.07 | $198.45 | $10.00 – $46.88 | 24 |
| Harvest allogeneic stem cell CPT 38205 | $5,531.25 | $9,218.75 | $1,382.81 – $7,835.94 | 16 |
| Harvest auto stem cells CPT 38206 | $4,464.59 | $7,440.99 | $564.62 – $5,580.74 | 24 |
| Harvest cultured skin graft 15040 CPT 15040 | $1,829.30 | $3,048.84 | $784.87 – $4,517.58 | 24 |
| Harvest stem cell concentrte CPT 38215 | $1,429.77 | $2,382.95 | $357.44 – $1,787.21 | 23 |
| Hast w/i&r phys/qhp CPT 94452 | $569.72 | $949.53 | $127.18 – $712.15 | 24 |
| Hast w/oxygen titrate CPT 94453 | $458.17 | $763.61 | $114.54 – $572.71 | 24 |
| Hba1/hba2 full gene sequence CPT 81259 | $1,101.45 | $1,835.75 | $35.00 – $1,440.00 | 24 |
| Hba1/hba2 gene dup/del vrnts CPT 81269 | $1,140.22 | $1,900.36 | $35.00 – $600.00 | 24 |
| Hbb full gene sequence CPT 81364 | $1,350.00 | $2,250.00 | $10.00 – $809.84 | 24 |
| Hbot, full body chamber, 30m HCPCS G0277 | $717.11 | $1,195.19 | $131.54 – $896.39 | 24 |
| Hc fl sm bowel enteroclss tube w kub double contrast CPT 74251 | $290.91 | $484.85 | $167.67 – $455.16 | 24 |
| Hcg qualitative CPT 84703 | $137.41 | $229.02 | $6.32 – $171.76 | 24 |
| Hcg quantitative CPT 84702 | $181.31 | $302.19 | $10.00 – $36.12 | 24 |
| Hc metata joint dislocation anes CPT 28635 | $1,964.56 | $3,274.27 | $593.04 – $3,981.46 | 24 |
| Hc nm fusion spect CT unlisted CPT 78999 | $463.68 | $772.80 | $316.07 – $1,021.72 | 24 |
| Hc nm kidney imaging with flow CPT 78701 | $651.59 | $1,085.99 | $205.83 – $1,021.72 | 24 |
| Hc nm myocard infarct avid plnr tomo spect w/wo quant CPT 78469 | $1,490.58 | $2,484.30 | $372.64 – $1,863.22 | 24 |
| Hc pet myocardial imaging metabolic eval single study CPT 78459 | $2,145.78 | $3,576.30 | $536.45 – $5,371.00 | 24 |
| Hc transcatheter placement and sbsq removal cepd perq CPT 33370 | $8,227.02 | $13,711.70 | $1,896.00 – $11,654.94 | 16 |
| Hdr rdncl ntrstl/icav brchtx CPT 77770 | $2,138.90 | $3,564.84 | $363.18 – $2,673.63 | 24 |
| Hdr rdncl ntrstl/icav brchtx CPT 77771 | $1,763.29 | $2,938.82 | $440.82 – $2,204.11 | 24 |
| Hdr rdncl ntrstl/icav brchtx CPT 77772 | $1,599.36 | $2,665.60 | $399.84 – $1,999.20 | 24 |
| Hdr rdncl skn surf brachytx CPT 77767 | $397.29 | $662.15 | $99.32 – $834.39 | 24 |
| Hdr rdncl skn surf brachytx CPT 77768 | $397.29 | $662.15 | $99.32 – $834.39 | 24 |
| Head CT scan (with and without contrast) CPT 70470 | $2,041.88 | $3,403.14 | $167.67 – $2,552.36 | 24 |
| Head CT scan (with contrast) CPT 70460 | $1,681.39 | $2,802.32 | $152.36 – $2,101.74 | 24 |
| Head CT scan (without contrast) CPT 70450 | $1,907.15 | $3,178.59 | $99.94 – $2,383.94 | 24 |
| Heart image spect CPT 78494 | $566.74 | $944.57 | $209.50 – $1,021.72 | 24 |
| Heart infarct image CPT 78466 | $840.74 | $1,401.23 | $160.05 – $1,050.92 | 24 |
| Heel (Calcaneus) X-ray (both feet) CPT 73650 | $121.09 | $201.81 | $28.74 – $225.11 | 24 |
| Heinz bodies induced CPT 85445 | $78.09 | $130.15 | $5.73 – $97.61 | 24 |
| Helicobacter pylori antibody igm CPT 86677 | $130.67 | $217.79 | $10.00 – $163.34 | 24 |
| Hemagglutination inhibition CPT 86280 | $73.26 | $122.10 | $6.88 – $91.58 | 24 |
| Hematocrit CPT 85014 | $45.98 | $76.63 | $1.99 – $57.47 | 24 |
| Hematopoietic nuclear tx CPT 79403 | $878.33 | $1,463.89 | $167.94 – $1,097.92 | 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.