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 |
|---|---|---|---|---|
| Laser surgery of prostate CPT 52648 | not published | not published | $1,689.43 – $12,818.21 | 17 |
| Laser surg penis lesion(s) CPT 54057 | not published | not published | $709.01 – $4,517.58 | 17 |
| Lateral canthopexy CPT 21282 | not published | not published | $886.62 – $7,975.81 | 17 |
| Lat retinacular release open CPT 27425 | not published | not published | $1,088.27 – $8,921.00 | 17 |
| Lb with mastopexy 15839 CPT 15839 | not published | not published | $2,763.00 – $7,039.11 | 17 |
| Lead acuity x4 spiral l 86cm HCPCS C1900 | $50,985.00 | $84,975.00 | $365.48 – $1,949.20 | 17 |
| Lead capillary CPT 83655 | $81.29 | $135.49 | $10.00 – $29.06 | 24 |
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $4,843.58 | $8,072.63 | $39.58 – $211.07 | 17 |
| Lead tachy durata sj4 58cm HCPCS C1777 | $10,186.81 | $16,978.01 | $285.07 – $1,520.38 | 17 |
| Lefort i-1 piece without graft CPT 21141 | not published | not published | $2,403.35 – $14,507.25 | 16 |
| Lefort i-3/> piece without graft CPT 21143 | not published | not published | $2,577.54 – $14,507.25 | 16 |
| Leg Artery Ultrasound (complete, both legs) CPT 93925 | $1,177.09 | $1,961.81 | $228.08 – $1,471.36 | 24 |
| Leg CT Scan (with contrast, both legs) CPT 73701 | $2,399.92 | $3,999.86 | $167.67 – $2,999.89 | 24 |
| Leg CT Scan (without contrast, both legs) CPT 73700 | $1,715.36 | $2,858.93 | $99.94 – $2,144.20 | 24 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,200.85 | $2,001.42 | $184.78 – $1,501.07 | 24 |
| Leishmania antibody CPT 86717 | $82.71 | $137.85 | $10.00 – $103.39 | 24 |
| Lengthening of thigh bone CPT 27466 | not published | not published | $2,073.24 – $15,697.77 | 15 |
| Lens, intraocular (new tech) HCPCS C1780 | $2,528.30 | $4,213.83 | $68.16 – $340.81 | 17 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $3,498.89 | $5,831.49 | $43.97 – $219.86 | 17 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $229.50 | $382.50 | $3.95 – $44.88 | 19 |
| Leukocyte phagocytosis CPT 86344 | $92.88 | $154.80 | $8.73 – $116.10 | 24 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $22,106.55 | $36,844.25 | $167.39 – $4,599.23 | 24 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $119.59 | $199.32 | $0.04 – $15.30 | 19 |
| Levetiracetam therapeutic drug level CPT 80177 | $138.12 | $230.20 | $10.00 – $172.65 | 24 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $49.98 | $83.30 | $2.38 – $34.85 | 19 |
| L hrt cath chd nm/abn nt cnj CPT 93595 | $7,452.60 | $12,421.00 | $1,863.15 – $9,315.75 | 23 |
| Liberta rc ipg HCPCS C1820 | $50,985.00 | $84,975.00 | $0.73 – $3.87 | 17 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $42.44 | $70.74 | $1.42 – $8.06 | 18 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $28.80 | $48.00 | $0.00 – $35.70 | 19 |
| Lidocaine therapeutic drug level CPT 80176 | $129.40 | $215.67 | $10.00 – $161.75 | 24 |
| Lifileucel til/dose 7.5b-72b snij HCPCS J9999 | $3.30 | $5.50 | $0.83 – $4.67 | 18 |
| Lift heel adj small gl60404sm HCPCS L3332 | $201.42 | $335.70 | $50.35 – $268.56 | 17 |
| Lifts elevation metal extens HCPCS L3330 | $927.30 | $1,545.50 | $231.82 – $1,236.40 | 17 |
| Ligate/strip long leg vein CPT 37722 | not published | not published | $1,118.22 – $7,896.23 | 17 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | not published | not published | $486.45 – $4,063.00 | 17 |
| Ligation/divis of long saph vein 37700 CPT 37700 | not published | not published | $1,118.22 – $7,896.23 | 17 |
| Ligation internal jugular vein 37565 CPT 37565 | $1,356.15 | $2,260.25 | $339.04 – $7,896.23 | 24 |
| Ligation/major artery/extremity 37618 CPT 37618 | $11,489.80 | $19,149.66 | $2,872.45 – $16,277.21 | 18 |
| Ligation major artery neck CPT 37615 | $3,608.40 | $6,014.00 | $902.10 – $7,896.23 | 24 |
| Ligation of abdomen artery 37617 CPT 37617 | $2,200.20 | $3,667.00 | $550.05 – $12,037.96 | 23 |
| Ligation vericose vein cluster(s) 1 leg CPT 37785 | $3,182.01 | $5,303.35 | $1,118.22 – $7,896.23 | 24 |
| Lig/band angioaccess av fistula CPT 37607 | $6,365.14 | $10,608.57 | $1,118.22 – $7,956.43 | 24 |
| Limited ankle motion ea jnt HCPCS L2200 | $160.99 | $268.32 | $40.25 – $214.66 | 17 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $335.91 | $559.85 | $2.73 – $172.55 | 19 |
| Lipase CPT 83690 | $130.62 | $217.70 | $5.79 – $16.54 | 24 |
| Lipoprotein blood high res frac & quant CPT 83701 | $112.29 | $187.15 | $10.00 – $140.36 | 24 |
| Lipoprotein blood quant CPT 83704 | $106.43 | $177.39 | $10.00 – $82.06 | 24 |
| Lipoprotein direct measurement hdl CPT 83718 | $113.88 | $189.80 | $6.88 – $25.15 | 24 |
| Lipoprotein direct measurement ldl CPT 83721 | $79.81 | $133.02 | $8.82 – $80.62 | 24 |
| Lip surgery procedure CPT 40799 | $433.65 | $722.75 | $180.69 – $605.10 | 24 |
| Lisocabtagene mara car pos t HCPCS Q2054 | $1,578,304.84 | $2,630,508.07 | $394,576.21 – $1,972,881.05 | 23 |
| Listeria monocytogenes CPT 86723 | $159.53 | $265.88 | $10.00 – $199.41 | 24 |
| Lithium therapeutic drug level CPT 80178 | $95.88 | $159.80 | $5.55 – $119.85 | 24 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | $12,380.88 | $20,634.80 | $3,095.22 – $17,539.58 | 17 |
| Liver ds alys 3 bmrk srm alg CPT 81517 | $660.00 | $1,100.00 | $35.00 – $751.09 | 24 |
| Liver elastography 91200 CPT 91200 | $312.00 | $520.00 | $31.93 – $390.00 | 24 |
| Liver Function Test CPT 80076 | $193.52 | $322.54 | $6.86 – $241.91 | 24 |
| Liver image (3d) with flow CPT 78206 | $1,198.66 | $1,997.76 | $118.23 – $669.97 | 18 |
| Liver imaging CPT 78201 | $1,279.10 | $2,131.83 | $175.43 – $1,598.87 | 24 |
| Liver imaging (3d) CPT 78205 | $1,198.66 | $1,997.76 | $299.66 – $1,698.10 | 18 |
| Liver imag w/vasclr flow CPT 78202 | $1,255.15 | $2,091.92 | $194.80 – $1,568.94 | 24 |
| Liver/spleen imag static only CPT 78215 | $1,471.52 | $2,452.54 | $180.10 – $1,839.40 | 24 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $504.82 | $841.37 | $135.99 – $1,021.72 | 24 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $1,088.27 – $8,018.48 | 17 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $161.06 | $268.44 | $1.27 – $228.17 | 19 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $12.92 | $21.53 | $0.17 – $1.83 | 19 |
| Low back disk surgery CPT 63030 | not published | not published | $2,398.52 – $17,722.46 | 16 |
| Low cost skin substitute app HCPCS C5271 | $1,126.12 | $1,876.87 | $281.53 – $1,595.34 | 19 |
| Low cost skin substitute app HCPCS C5273 | $1,584.24 | $2,640.40 | $396.06 – $4,517.58 | 19 |
| Low cost skin substitute app HCPCS C5275 | $1,313.06 | $2,188.44 | $328.27 – $1,860.17 | 19 |
| Low cost skin substitute app HCPCS C5277 | not published | not published | $839.96 – $3,693.00 | 4 |
| Low cost skin substitute app HCPCS C5272 | $693.49 | $1,155.81 | $173.37 – $982.44 | 18 |
| Low cost skin substitute app HCPCS C5274 | $769.45 | $1,282.42 | $192.36 – $1,090.06 | 18 |
| Low cost skin substitute app HCPCS C5276 | $2,428.65 | $4,047.75 | $607.16 – $3,440.59 | 18 |
| Low cost skin substitute app HCPCS C5278 | not published | not published | $1,896.00 – $1,896.00 | 1 |
| Low-Dose Lung Cancer Screening CT Scan CPT 71271 | $184.05 | $306.75 | $99.94 – $1,841.00 | 24 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $1,677.35 | $2,795.59 | $167.67 – $2,096.69 | 24 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $2,381.40 | $3,969.00 | $173.75 – $2,976.75 | 24 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $2,054.79 | $3,424.65 | $99.94 – $2,568.49 | 24 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $3,196.33 | $5,327.21 | $329.13 – $3,995.41 | 24 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,181.58 | $3,635.96 | $279.00 – $2,726.97 | 24 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,190.02 | $3,650.03 | $197.14 – $2,737.52 | 24 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $337.54 | $562.56 | $40.10 – $421.92 | 24 |
| Lower Back (Lumbar Spine) X-ray (4 or more views) CPT 72110 | $475.04 | $791.73 | $52.13 – $593.80 | 24 |
| Lower Back (Lumbar Spine) X-ray (with bending views) CPT 72114 | $535.91 | $893.19 | $61.48 – $669.89 | 24 |
| Lower Leg (Shin) X-ray (both sides) CPT 73590 | $306.47 | $510.79 | $31.74 – $383.09 | 24 |
| Low frequency non-thermal Ultrasound CPT 97610 | $364.77 | $607.95 | $91.19 – $495.95 | 24 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $3,110.01 – $25,500.18 | 16 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $9,126.00 – $25,500.18 | 16 |
| Lso sagit rigid panel prefab HCPCS L0635 | $1,513.13 | $2,521.88 | $378.28 – $2,017.50 | 17 |
| L/s ratio fetal lung CPT 83661 | $254.12 | $423.53 | $10.00 – $317.65 | 24 |
| Lumbar diskogram s&i CPT 72295 | $2,358.23 | $3,930.39 | $111.60 – $4,783.04 | 24 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $7,038.00 – $46,166.33 | 16 |
| Lumizyme injection HCPCS J0221 | $1,735.97 | $2,893.29 | $187.25 – $1,891.44 | 24 |
| Lung Function Test Before and After an Inhaler CPT 94060 | $628.51 | $1,047.51 | $144.93 – $807.28 | 24 |
| Lung function test (mbc/mvv) CPT 94200 | $214.94 | $358.24 | $53.74 – $268.68 | 24 |
| Lung Function Test (Spirometry) CPT 94010 | $405.67 | $676.12 | $101.42 – $507.09 | 24 |
| Lung perfusion imaging CPT 78580 | $1,348.42 | $2,247.36 | $213.51 – $1,685.52 | 24 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $21,365.20 | $35,608.66 | $38.76 – $8,916.19 | 24 |
| Lvad shower bag heartmate HCPCS Q0501 | $837.59 | $1,395.99 | $80.25 – $596.45 | 18 |
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.