BAYLOR SCOTT & WHITE MCLANE CHILDREN'S MEDICAL CENTER
1901 SW HK Dodgen Loop, Temple, TX · Baylor Scott & White Health · · NPI 1477516466
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 |
|---|---|---|---|---|
| Destroy premlg lesns;1st lesn 17000 CPT 17000 | $168.26 | $280.43 | $42.06 – $495.95 | 29 |
| Destroy vulva lesion extensive 56515 CPT 56515 | $3,712.10 | $6,186.83 | $71.00 – $5,568.15 | 29 |
| Destroy vulva lesion simple 56501 CPT 56501 | $3,887.49 | $6,479.15 | $71.00 – $5,831.23 | 29 |
| Destruct ben lesion 15/> 17111 CPT 17111 | $376.54 | $627.56 | $71.00 – $564.80 | 29 |
| Destruct cut vasl lesions 10-50cm 17107 CPT 17107 | $1,150.10 | $1,916.83 | $71.00 – $2,975.00 | 29 |
| Destruct cut vasl lesions <10cm 17106 CPT 17106 | $887.10 | $1,478.50 | $71.00 – $1,330.65 | 29 |
| Destruct cut vasl lesions >50cm 17108 CPT 17108 | $1,602.40 | $2,670.66 | $71.00 – $4,517.58 | 29 |
| Destruction 2-14 lesions 17003 CPT 17003 | $78.61 | $131.01 | $19.65 – $117.91 | 22 |
| Destruction anal lesion(s) CPT 46910 | $3,110.86 | $5,184.76 | $160.02 – $5,388.00 | 27 |
| Destruction anal lesion(s) CPT 46924 | $3,363.79 | $5,606.32 | $939.93 – $6,955.62 | 27 |
| Destruction anal lesion(s) smpl chem 46900 CPT 46900 | $535.46 | $892.44 | $137.87 – $2,975.00 | 27 |
| Destruction benign lesions < 14 lesions CPT 17110 | $197.32 | $328.87 | $49.33 – $495.95 | 29 |
| Destruction by injection tx of nerve 64630 CPT 64630 | $1,626.35 | $2,710.58 | $71.00 – $3,421.00 | 29 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | $1,208.75 | $2,014.59 | $71.00 – $1,813.13 | 22 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $2,989.87 | $4,983.11 | $71.00 – $5,645.00 | 29 |
| Destruction ciliary body CPT 66720 | $3,293.41 | $5,489.01 | $71.00 – $5,788.85 | 29 |
| Destruction ciliary body CPT 66740 | $2,188.86 | $3,648.10 | $71.00 – $5,788.85 | 29 |
| Destruction cryosurgery anal lesion(s) simpl 46916 CPT 46916 | $328.95 | $548.25 | $74.34 – $495.95 | 27 |
| Destruction laser surgery anal lesions 46917 CPT 46917 | $2,770.80 | $4,618.00 | $939.93 – $6,955.62 | 27 |
| Destruction les conjunctiva CPT 68135 | $1,569.81 | $2,616.35 | $70.60 – $5,788.85 | 29 |
| Destruction mal lsn s/n/h/f/g 2.1-3cm CPT 17273 | $661.99 | $1,103.31 | $71.00 – $992.98 | 29 |
| Destruction mal lsn s/n/h/f/g 3.1-4cm CPT 17274 | $461.84 | $769.73 | $71.00 – $2,975.00 | 29 |
| Destruction mal lsn t/a/l 3.1-4cm CPT 17264 | $527.99 | $879.99 | $71.00 – $987.79 | 29 |
| Destruction mal lsn t/a/l >4cm CPT 17266 | $767.22 | $1,278.70 | $71.00 – $2,975.00 | 29 |
| Destruction penis lesion(s) chem 54050 CPT 54050 | $221.39 | $368.99 | $55.35 – $987.79 | 29 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | $3,556.35 | $5,927.25 | $71.00 – $5,334.52 | 29 |
| Destruction premal lesions 15/> 17004 CPT 17004 | $657.25 | $1,095.42 | $97.18 – $987.79 | 26 |
| Destruction rectal tumor 45190 CPT 45190 | $2,998.42 | $4,997.36 | $939.93 – $8,649.00 | 27 |
| Destruction vag lesions complex 57065 CPT 57065 | $3,302.03 | $5,503.38 | $71.00 – $7,744.80 | 29 |
| Destruction vag lesions simple 57061 CPT 57061 | $3,299.39 | $5,498.98 | $71.00 – $7,744.80 | 29 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | $2,236.85 | $3,728.09 | $71.00 – $5,388.00 | 29 |
| Detect agent nos dna dir CPT 87797 | $186.00 | $310.00 | $12.00 – $179.45 | 29 |
| Detect agnt mult dna direc CPT 87800 | $175.12 | $291.87 | $12.00 – $262.68 | 29 |
| Determination venous press CPT 93770 | $167.73 | $279.55 | $25.04 – $251.59 | 22 |
| Determine refractive state CPT 92015 | $6.09 | $10.15 | $1.52 – $59.86 | 22 |
| Devel tst phys/qhp 1st hr CPT 96112 | $105.91 | $176.51 | $26.48 – $386.96 | 29 |
| Device ablt adv novasure HCPCS C1886 | $9,177.30 | $15,295.50 | $241.94 – $1,451.66 | 22 |
| Device hemospray 7frx220cm endo hemostat min access HCPCS C1052 | $5,098.50 | $8,497.50 | $39.57 – $7,647.75 | 22 |
| Device intraute mirena HCPCS J7298 | $2,082.22 | $3,470.37 | $520.56 – $3,123.33 | 22 |
| Device tiss remov myosure reach HCPCS C1782 | $2,541.00 | $4,235.00 | $169.78 – $1,018.71 | 22 |
| Dev interrog remote 1/2/mlt CPT 93295 | $272.69 | $454.49 | $68.17 – $917.00 | 22 |
| Devlopment test interpt&rep HCPCS G0451 | $112.13 | $186.88 | $28.03 – $220.82 | 29 |
| Dev tst admin phys/qhp ea addl 30 min CPT 96113 | $223.51 | $372.52 | $55.88 – $335.27 | 22 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $372.51 | $620.85 | $31.74 – $558.76 | 29 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $85.86 | $143.10 | $0.03 – $0.31 | 23 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $27.00 | $45.00 | $0.12 – $10.53 | 23 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | $1,268.38 | $2,113.97 | $47.25 – $951.26 | 29 |
| Dextran 40 infusion HCPCS J7100 | $151.20 | $252.00 | $37.80 – $226.80 | 22 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $28.80 | $48.00 | $1.12 – $6.75 | 23 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $28.80 | $48.00 | $6.30 – $37.80 | 22 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $31.32 | $52.20 | $2.06 – $12.69 | 23 |
| Dextrose 5 % IV bolus HCPCS J7070 | $35.74 | $59.57 | $3.38 – $22.41 | 23 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $153.80 | $256.33 | $12.00 – $230.70 | 29 |
| Diabetes (HbA1c) Test CPT 83036 | $92.09 | $153.48 | $8.16 – $129.45 | 29 |
| Diabetes training group per 30 min g0109 HCPCS G0136 | $35.43 | $59.05 | $8.86 – $71.08 | 26 |
| Diab manage trn ind/group HCPCS G0109 | $63.45 | $105.75 | $15.86 – $95.17 | 22 |
| Diag laparo separate proc 49320 CPT 49320 | $7,144.88 | $11,908.13 | $71.00 – $14,293.73 | 29 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $134.55 | $224.25 | $33.64 – $316.45 | 29 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $117.94 | $196.56 | $29.48 – $316.04 | 22 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $75.93 | $126.55 | $18.98 – $316.04 | 22 |
| Diagnostic laryngoscopy 31505 CPT 31505 | $242.14 | $403.56 | $56.20 – $490.70 | 29 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $374.65 | $624.42 | $68.14 – $561.98 | 29 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $340.20 | $567.00 | $85.05 – $510.30 | 22 |
| Diagnostic Mammogram (one breast) CPT 77065 | $272.16 | $453.60 | $68.04 – $408.24 | 22 |
| Diagnostic radio unlisted proc CPT 76499 | $6,139.57 | $10,232.61 | $83.05 – $3,328.78 | 29 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | $2,978.93 | $4,964.89 | $71.00 – $4,468.40 | 22 |
| Dialysis one evaluation CPT 90945 | $1,775.84 | $2,959.74 | $398.20 – $2,663.77 | 29 |
| Dialysis repeated eval CPT 90947 | $1,523.40 | $2,539.00 | $380.85 – $2,285.10 | 22 |
| Dialysis training complete CPT 90989 | $783.36 | $1,305.60 | $195.84 – $1,175.04 | 22 |
| Dialysis training incompl CPT 90993 | $391.67 | $652.78 | $97.92 – $587.50 | 22 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $149.04 | $248.40 | $0.08 – $174.96 | 23 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $135.30 | $225.50 | $3.25 – $19.48 | 23 |
| Dicyclomine injection HCPCS J0500 | $229.36 | $382.26 | $0.18 – $10.30 | 23 |
| Diffusing capacity CPT 94729 | $434.72 | $724.54 | $108.68 – $652.09 | 22 |
| Digital analysis of eeg CPT 95957 | $641.56 | $1,069.26 | $160.39 – $962.33 | 22 |
| Digit nerve surgery add-on CPT 64778 | $1,832.59 | $3,054.32 | $71.00 – $2,748.89 | 22 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $371.87 | $619.79 | $2.59 – $15.56 | 23 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | $8,613.00 | $14,355.00 | $2,153.25 – $12,919.50 | 29 |
| Digoxin total therapeutic drug level CPT 80162 | $102.07 | $170.12 | $11.16 – $153.11 | 29 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $357.05 | $595.08 | $51.76 – $310.55 | 23 |
| Dilate biliary duct/ampulla CPT 47542 | $2,316.61 | $3,861.01 | $71.00 – $3,474.91 | 22 |
| Dilate esophagus CPT 43453 | $1,053.98 | $1,756.63 | $564.97 – $4,713.77 | 27 |
| Dilate esophagus 1/mult pass CPT 43450 | $1,349.05 | $2,248.42 | $334.95 – $2,975.00 | 27 |
| Dilate ic vasospasm ea add vsl diff territory CPT 61642 | $2,932.13 | $4,886.89 | $556.75 – $4,398.20 | 20 |
| Dilate ic vasospasm ea add vsl same territory CPT 61641 | $1,190.10 | $1,983.50 | $278.38 – $3,421.00 | 20 |
| Dilate ic vasospasm init CPT 61640 | $4,627.52 | $7,712.54 | $792.71 – $6,941.29 | 20 |
| Dilate tear duct opening CPT 68801 | $351.48 | $585.80 | $71.00 – $987.04 | 29 |
| Dilate urethra stricture CPT 53600 | $910.83 | $1,518.05 | $34.88 – $1,366.24 | 29 |
| Dilate urethra stricture CPT 53601 | $208.22 | $347.04 | $39.07 – $2,975.00 | 29 |
| Dilate urethra stricture CPT 53605 | $3,424.84 | $5,708.06 | $71.00 – $8,636.11 | 29 |
| Dilate urethra stricture CPT 53621 | $450.25 | $750.42 | $71.00 – $2,975.00 | 29 |
| Dilation/female urethra/initial 53660 CPT 53660 | $277.58 | $462.63 | $39.59 – $416.37 | 29 |
| Dilation of anal sphincter CPT 45905 | $2,166.04 | $3,610.06 | $429.26 – $3,249.05 | 27 |
| Dilation of cervical canal 57800 CPT 57800 | $4,096.04 | $6,826.74 | $39.86 – $7,744.80 | 29 |
| Dilation of rectal stricture 45910 CPT 45910 | $2,263.80 | $3,773.00 | $429.26 – $3,395.70 | 27 |
| Dilation of salivary duct CPT 42660 | $551.84 | $919.74 | $57.03 – $1,363.00 | 29 |
| Dilation of urethra CPT 53661 | $275.49 | $459.15 | $29.60 – $413.24 | 29 |
| Dilation of urethra CPT 53665 | $3,636.97 | $6,061.62 | $71.00 – $5,455.46 | 29 |
| Dilation of vagina CPT 57400 | $2,643.08 | $4,405.13 | $71.00 – $7,744.80 | 29 |
| Dilation salivary duct 42650 CPT 42650 | $2,498.32 | $4,163.87 | $37.38 – $3,777.93 | 29 |
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.