BAYLOR SCOTT & WHITE MEDICAL CENTER - IRVING
1901 N. MacArthur Blvd., Irving, TX · Baylor Scott & White Health · · NPI 1992700983
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 |
|---|---|---|---|---|
| Clsd tx shoulder disloc w/anatom neck fx w/manip 23675 CPT 23675 | $1,797.83 | $2,996.38 | $593.04 – $3,981.46 | 25 |
| Clsd tx/shoulder dislo/manip/anest 23655 CPT 23655 | $3,062.63 | $5,104.38 | $593.04 – $3,981.46 | 25 |
| Clsd tx/talotarsal dislocat/anes 28575 CPT 28575 | $3,848.69 | $6,414.49 | $1,088.27 – $8,018.48 | 25 |
| Clsd tx temporomandibular dislocat 21480 CPT 21480 | $512.40 | $854.00 | $85.32 – $640.50 | 25 |
| Clsd tx toe dislocation without anes28660 CPT 28660 | $598.58 | $997.63 | $59.25 – $748.22 | 25 |
| Clsd tx trimall ankle fx without manip 27816 CPT 27816 | $713.23 | $1,188.72 | $85.32 – $891.54 | 25 |
| Clsd tx trimall ankle fx w/manip 27818 CPT 27818 | $1,565.74 | $2,609.56 | $593.04 – $3,981.46 | 25 |
| Clsd tx/ulnar shaft fx without manip 25530 CPT 25530 | $593.29 | $988.82 | $85.32 – $741.62 | 25 |
| Clsd tx wrist scaphoid fx without manip 25622 CPT 25622 | $543.23 | $905.39 | $85.32 – $679.04 | 25 |
| Clsd tx wrist ulnar styloid fx 25650 CPT 25650 | $705.55 | $1,175.92 | $85.32 – $881.94 | 25 |
| Cls tx of heel fracture w/manip 28405 CPT 28405 | $5,766.26 | $9,610.44 | $85.32 – $7,207.83 | 25 |
| Cltx carpl scphd fx w/mnpj CPT 25624 | $2,128.12 | $3,546.87 | $593.04 – $3,981.46 | 25 |
| Cltx humrl cndylr fx w/mnpj CPT 24577 | $1,534.94 | $2,558.24 | $593.04 – $3,981.46 | 25 |
| Cltx lunate dislc w/mnpj CPT 25690 | $2,952.64 | $4,921.06 | $593.04 – $3,981.46 | 25 |
| Cltx mndblr fx ntrdntl fixj CPT 21453 | $5,807.49 | $9,679.15 | $1,954.22 – $14,507.25 | 25 |
| Cltx mndblr fx w/mnpj CPT 21451 | $3,847.80 | $6,413.00 | $420.64 – $4,809.75 | 25 |
| Cltx mndblr/max alv ridge fx CPT 21440 | $4,811.92 | $8,019.87 | $468.98 – $7,975.81 | 25 |
| Cltx palatal/max fx wire fix CPT 21421 | $4,377.24 | $7,295.40 | $886.62 – $7,975.81 | 25 |
| Cltx post ankle fx w/mnpj CPT 27768 | $2,621.81 | $4,369.68 | $850.02 – $3,981.46 | 25 |
| Cltx scap fx w/mnpj +-tractj CPT 23575 | $2,050.29 | $3,417.15 | $593.04 – $3,981.46 | 25 |
| Cltx strnclav dislc w/mnpj CPT 23525 | $722.16 | $1,203.60 | $85.32 – $902.70 | 25 |
| Cltx thigh fx w/mnpj CPT 27268 | $3,503.71 | $5,839.52 | $642.35 – $4,379.64 | 24 |
| Cltx tmprmand dislc comp CPT 21485 | $3,445.34 | $5,742.23 | $420.64 – $4,306.67 | 25 |
| C motor evoked lwr limbs CPT 95929 | $621.00 | $1,035.00 | $113.85 – $1,327.77 | 25 |
| C motor evoked uppr limbs CPT 95928 | $649.09 | $1,081.81 | $119.00 – $2,590.07 | 25 |
| C motor evoked upr&lwr limbs CPT 95939 | $1,568.20 | $2,613.66 | $287.50 – $2,590.07 | 25 |
| Cmptr ophth dx img ant segmt CPT 92132 | $130.41 | $217.35 | $23.91 – $163.01 | 25 |
| Cmptr ophth img optic nerve CPT 92133 | $207.29 | $345.49 | $38.00 – $259.12 | 25 |
| #cms hgb-sulfhemoglobin CPT 83060 | $75.58 | $125.96 | $7.39 – $56.47 | 25 |
| #cmvcul-virus inoculation shell CPT 87254 | $133.00 | $221.67 | $10.00 – $166.25 | 25 |
| Cmv pcr-sendout CPT 87496 | $786.79 | $1,311.32 | $10.00 – $133.12 | 25 |
| Cnbp gene detc abnor allele CPT 81187 | $7,487.95 | $12,479.92 | $35.00 – $9,359.94 | 25 |
| Co2 monitor per day CPT 94681 | $483.66 | $806.10 | $88.67 – $805.95 | 25 |
| Coagulation factor viia 1,000 mcg/ml inj 1 ml HCPCS J7189 | $26.45 | $44.08 | $2.51 – $33.06 | 25 |
| Coagulation time activated teg CPT 85347 | $99.66 | $166.10 | $3.60 – $124.58 | 25 |
| Cocm by rhc/fqhc 60 min mo HCPCS G0512 | $87.13 | $145.21 | $15.97 – $190.31 | 19 |
| Cogenex amnio memb per sq cm HCPCS Q4229 | $0.01 | $0.01 | $0.00 – $268.77 | 24 |
| Cold agglutinin screen (arc) CPT 86156 | $128.26 | $213.77 | $6.78 – $160.33 | 25 |
| Cold agglutinin titer CPT 86157 | $83.66 | $139.44 | $6.77 – $104.58 | 25 |
| Colistimethate sodium inj HCPCS J0770 | $103.76 | $172.94 | $15.69 – $147.00 | 20 |
| Collagen based wound filler HCPCS A6010 | $1,096.43 | $1,827.38 | $56.13 – $1,130.78 | 19 |
| Collarbone (Clavicle) X-ray (both sides) CPT 73000 | $236.29 | $393.82 | $32.75 – $295.37 | 25 |
| Collar cerv 18.25x3.5in serp firm density sm HCPCS L0120 | $482.43 | $804.05 | $14.82 – $107.81 | 18 |
| Collar cerv ascend 172 reg HCPCS L0172 | $286.37 | $477.28 | $13.84 – $100.67 | 18 |
| Collar extrication adult univ HCPCS L0200 | $907.63 | $1,512.72 | $95.59 – $695.20 | 18 |
| Collection blood specimen from completely implantable venous access device CPT 36591 | $202.31 | $337.19 | $10.00 – $316.45 | 25 |
| Collection blood specimen using established central/peripheral catheter venous nos CPT 36592 | $192.03 | $320.05 | $10.00 – $316.45 | 25 |
| Collj & interpj data ea 30 d CPT 99091 | $174.20 | $290.34 | $31.94 – $246.79 | 15 |
| Colporrhapy/vag injury sut/non ob 57200 CPT 57200 | $3,907.93 | $6,513.21 | $1,063.52 – $7,744.80 | 25 |
| Colposcopy/cervix/inc up/adjacent vag 57452 CPT 57452 | $139.80 | $233.00 | $56.75 – $493.64 | 25 |
| Colposcopy vulva 56820 CPT 56820 | $90.00 | $150.00 | $55.10 – $493.64 | 25 |
| Colpotomy w/exploration 57000 CPT 57000 | $2,788.64 | $4,647.74 | $1,063.52 – $7,744.80 | 25 |
| Compatibility test each unit antiglobulin technique CPT 86922 | $182.86 | $304.77 | $10.00 – $423.12 | 25 |
| Compatibility test each unit electronic CPT 86923 | $188.22 | $313.70 | $10.00 – $423.12 | 25 |
| Compatibility test each unit immediate spin technique CPT 86920 | $169.52 | $282.54 | $10.00 – $423.12 | 25 |
| Complement antigen each component c3 CPT 86160 | $542.33 | $903.88 | $10.00 – $28.80 | 25 |
| Complex repair trunk 1.1-2.5cm 13120 CPT 13120 | $1,109.03 | $1,848.38 | $216.80 – $1,555.84 | 25 |
| Complex repair trunk 2.6-7.5cm 13101 CPT 13101 | $1,612.19 | $2,686.99 | $216.80 – $1,596.25 | 25 |
| Complx repair enel 1.1-2.5 cm 13151 CPT 13151 | $1,278.25 | $2,130.41 | $216.80 – $1,597.81 | 25 |
| Complx repair enel 2.6-7.5 cm 13152 CPT 13152 | $1,622.55 | $2,704.25 | $216.80 – $2,028.19 | 25 |
| Complx repair enel addl 5cm/< 13153 CPT 13153 | $680.92 | $1,134.86 | $124.83 – $964.63 | 18 |
| Complx repair fccmnaxghf 13131 CPT 13131 | $1,065.98 | $1,776.63 | $143.08 – $1,332.47 | 25 |
| Complx repair fccmnaxghf 13132 CPT 13132 | $1,528.04 | $2,546.74 | $216.80 – $1,910.06 | 25 |
| Complx repair fccmnaxghf 13133 CPT 13133 | $896.48 | $1,494.14 | $164.36 – $1,270.02 | 18 |
| Complx repair sal addl 5 cm/> 13122 CPT 13122 | $592.69 | $987.81 | $108.66 – $839.64 | 19 |
| Complx repair trunk 1.1-2.5 cm 13100 CPT 13100 | $1,427.85 | $2,379.75 | $216.80 – $1,784.81 | 25 |
| Complx repair trunk addl 5cm/< 13102 CPT 13102 | $1,267.55 | $2,112.59 | $139.96 – $1,081.50 | 19 |
| Computed tomographic angiography head and neck with contrast CPT 70471 | $7,050.71 | $11,751.19 | $332.94 – $8,813.39 | 24 |
| Concentration infection agents any type CPT 87015 | $51.32 | $85.54 | $5.61 – $22.05 | 25 |
| Condylomata destruction 56420 CPT 56420 | $509.81 | $849.69 | $70.52 – $637.27 | 25 |
| Conivaptan hcl HCPCS C9488 | $1,611.54 | $2,685.90 | $122.82 – $2,283.01 | 20 |
| Conjugated estrogens 25 mg solution for injection HCPCS J1410 | $993.74 | $1,656.23 | $182.19 – $1,242.17 | 25 |
| Connect omega .5mm HCPCS L8613 | $1,447.28 | $2,412.14 | $73.17 – $532.15 | 18 |
| Connector tis 2x10mm HCPCS C9352 | $3,862.15 | $6,436.92 | $294.07 – $2,138.70 | 18 |
| Consultation pathology during surgery CPT 88329 | $134.66 | $224.43 | $24.69 – $168.32 | 25 |
| Consultation pathology during surgery cytological exam initial site CPT 88333 | $461.95 | $769.91 | $35.00 – $2,130.15 | 25 |
| Consultation pathology during surgery frozen section each additional block CPT 88332 | $154.18 | $256.96 | $28.27 – $218.42 | 19 |
| Consultation pathology during surgery frozen section first tissue block CPT 88331 | $297.87 | $496.45 | $35.00 – $423.12 | 25 |
| Consultation/report referred material w/preparation of slides CPT 88323 | $275.42 | $459.04 | $35.00 – $344.28 | 25 |
| Consultation/report referred slides prepared elsewhere CPT 88321 | $171.65 | $286.09 | $10.00 – $214.57 | 25 |
| Consultation with family CPT 90887 | $135.79 | $226.31 | $24.89 – $192.36 | 19 |
| Consult comp w/report rfrd material CPT 88325 | $425.93 | $709.88 | $35.00 – $532.41 | 25 |
| Contrast baths charges CPT 97034 | $87.17 | $145.28 | $15.98 – $134.00 | 20 |
| Contrast exam abdominl aorta 75625-26 CPT 75625 | $3,389.09 | $5,648.49 | $126.64 – $7,896.23 | 25 |
| Contrast exam thoracic aorta CPT 75600 | $3,570.00 | $5,950.00 | $182.78 – $7,896.23 | 25 |
| Contrast exam thoracic aorta 75605-26 CPT 75605 | $3,167.26 | $5,278.77 | $120.95 – $13,613.39 | 25 |
| Contrast x-ray gallbladder CPT 74290 | $186.25 | $310.41 | $85.20 – $455.16 | 25 |
| Contrast x-ray of ankle CPT 73615 | $495.58 | $825.96 | $128.31 – $952.69 | 25 |
| Contrast x-ray of brain CPT 70015 | $1,336.32 | $2,227.20 | $166.40 – $1,983.49 | 25 |
| Contrast x-ray of elbow CPT 73085 | $495.60 | $826.00 | $100.24 – $952.69 | 25 |
| Contrast x-ray of hip CPT 73525 | $520.38 | $867.30 | $129.31 – $952.69 | 25 |
| Contrast x-ray of knee joint CPT 73580 | $495.60 | $826.00 | $110.94 – $952.69 | 25 |
| Contrast x-ray of wrist CPT 73115 | $495.58 | $825.96 | $135.33 – $952.69 | 25 |
| Controler lvad heartmate 3 includes ebb HCPCS Q0481 | $16,559.40 | $27,599.00 | $171.42 – $1,246.72 | 18 |
| Controller infinity pt dbs HCPCS C1787 | $35,689.50 | $59,482.50 | $0.00 – $0.01 | 19 |
| Control nosebleed pack+caut 30905 CPT 30905 | $460.17 | $766.95 | $46.68 – $575.21 | 25 |
| Control of nosebleed ant comp 30903 CPT 30903 | $410.06 | $683.43 | $46.68 – $512.57 | 25 |
| Control of nosebleedantersmpl 30901 CPT 30901 | $461.69 | $769.49 | $84.64 – $577.12 | 25 |
| Control oropharyngeal hemorr/simp 42960 CPT 42960 | $682.33 | $1,137.21 | $187.22 – $1,363.00 | 25 |
| Contrst x-ray uppr gi tract CPT 74249 | $762.93 | $1,271.55 | $139.87 – $1,080.82 | 19 |
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.