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 |
|---|---|---|---|---|
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | $4,801.65 | $8,002.75 | $71.00 – $8,018.48 | 29 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | $96.88 | $161.46 | $12.00 – $145.31 | 29 |
| Ghs reticulocyte count CPT 85044 | $54.25 | $90.42 | $3.62 – $81.38 | 29 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $153.45 | $255.75 | $11.68 – $230.18 | 29 |
| Ghs sedimentation rate CPT 85651 | $48.29 | $80.49 | $3.59 – $72.44 | 29 |
| Ghs semen analysis fert CPT 89320 | $170.87 | $284.79 | $11.69 – $256.31 | 29 |
| Ghs semen analysis, post-vas CPT 89300 | $46.20 | $77.00 | $9.35 – $69.30 | 29 |
| Ghs sensitivity (per antimicro) CPT 87184 | $98.18 | $163.64 | $6.28 – $147.28 | 29 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $563.75 | $939.59 | $71.00 – $987.79 | 29 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $563.75 | $939.59 | $71.00 – $987.79 | 29 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $563.75 | $939.59 | $71.00 – $987.79 | 29 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $380.64 | $634.40 | $71.00 – $987.79 | 29 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $538.64 | $897.74 | $71.00 – $807.97 | 29 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $470.47 | $784.12 | $71.00 – $705.71 | 29 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $538.64 | $897.74 | $71.00 – $807.97 | 29 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $471.32 | $785.53 | $71.00 – $706.98 | 29 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $687.68 | $1,146.13 | $71.00 – $1,031.52 | 29 |
| Ghs sleep study unattended CPT 95800 | $503.38 | $838.97 | $125.85 – $2,062.00 | 29 |
| Ghs somatosensory testing lower extremit CPT 95926 | $1,135.79 | $1,892.98 | $206.06 – $1,703.68 | 29 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $1,506.58 | $2,510.96 | $376.64 – $2,259.86 | 29 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $176.10 | $293.50 | $44.02 – $264.15 | 23 |
| Ghs sphenopalatine ganglion block CPT 64505 | $788.03 | $1,313.39 | $70.60 – $1,182.05 | 29 |
| Ghs spont nystagmus CPT 92541 | $258.47 | $430.79 | $64.62 – $387.71 | 29 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $310.01 | $516.68 | $77.50 – $465.01 | 23 |
| Ghs st - eval for alt comm CPT 92567 | $115.82 | $193.04 | $28.96 – $173.74 | 29 |
| Ghs strapping shoulder - 29240 CPT 29240 | $243.07 | $405.12 | $60.77 – $364.61 | 29 |
| Ghs st - re-eval for alt comm CPT 92597 | $439.36 | $732.26 | $109.84 – $659.03 | 23 |
| Ghs subcutaneous infus, for therapy ea. add. hr CPT 96370 | $117.50 | $195.83 | $29.37 – $176.25 | 29 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | $545.75 | $909.59 | $136.44 – $818.63 | 29 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $1,444.46 | $2,407.43 | $71.00 – $2,166.69 | 29 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $696.68 | $1,161.14 | $71.00 – $1,045.03 | 29 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $1,456.55 | $2,427.58 | $71.00 – $3,777.93 | 29 |
| Ghs trypsin (fecal) CPT 84488 | $79.83 | $133.05 | $6.13 – $119.75 | 29 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $575.05 | $958.42 | $71.00 – $862.58 | 29 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | $486.35 | $810.59 | $71.00 – $729.53 | 29 |
| Ghs urine, hydroxproline total CPT 83505 | $186.16 | $310.27 | $12.00 – $279.24 | 29 |
| Ghs urine, porphyrins quant CPT 84120 | $133.55 | $222.59 | $12.00 – $64.24 | 29 |
| Ghs vaginal delivery only CPT 59409 | $4,160.90 | $6,934.83 | $71.00 – $7,744.80 | 29 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $4,763.99 | $7,939.98 | $356.12 – $7,145.98 | 29 |
| Ghs windowing of cast CPT 29730 | $212.55 | $354.25 | $27.69 – $390.34 | 29 |
| Giardia ag if CPT 87269 | $78.00 | $130.00 | $11.43 – $117.00 | 29 |
| Giardia lamblia antibody CPT 86674 | $94.15 | $156.92 | $12.00 – $141.23 | 29 |
| Gi endoscopic ultrasound CPT 76975 | $582.31 | $970.51 | $110.35 – $873.46 | 29 |
| Gi inhouse confirmation CPT 87045 | $111.95 | $186.58 | $7.93 – $167.92 | 29 |
| Gingivoplasty each quadrant CPT 41872 | $2,730.39 | $4,550.65 | $71.00 – $7,975.81 | 29 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $1,992.73 | $3,321.21 | $732.90 – $2,989.09 | 27 |
| Gi trc img intral esophagus CPT 91111 | $2,367.34 | $3,945.56 | $865.56 – $3,551.00 | 27 |
| Gi wireless capsule measure CPT 91112 | $1,201.70 | $2,002.83 | $700.99 – $2,245.59 | 27 |
| Gjb2 gene full sequence CPT 81252 | $628.20 | $1,047.00 | $12.00 – $942.30 | 29 |
| Gjb2 gene known fam variants CPT 81253 | $73.82 | $123.04 | $36.00 – $147.65 | 29 |
| Gjb6 gene com variants CPT 81254 | $360.19 | $600.31 | $29.40 – $540.28 | 29 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | $116.17 | $193.61 | $27.61 – $174.25 | 29 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | $76.08 | $126.80 | $19.02 – $114.12 | 29 |
| Glaucoma surgery CPT 66160 | $3,895.82 | $6,493.03 | $71.00 – $5,843.73 | 29 |
| Glaucoma surgery CPT 66170 | $4,786.53 | $7,977.55 | $71.00 – $7,179.80 | 29 |
| Glove finger flexion right lg xl HCPCS L3912 | $114.00 | $190.00 | $4.80 – $28.80 | 21 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $682.24 | $1,137.06 | $41.04 – $246.24 | 29 |
| Glucagon plasma - sendout CPT 82943 | $114.41 | $190.68 | $12.00 – $171.61 | 29 |
| Glucagon tolerance test CPT 82946 | $111.95 | $186.58 | $12.00 – $167.92 | 29 |
| Glucose 1 hr post dose CPT 82950 | $60.77 | $101.29 | $3.99 – $91.16 | 29 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | $72.12 | $120.20 | $5.08 – $108.18 | 29 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $33.96 | $56.60 | $3.12 – $50.94 | 29 |
| Glucose blood quantitative CPT 82947 | $109.53 | $182.55 | $3.30 – $77.62 | 29 |
| Glucose body fluid CPT 82945 | $79.18 | $131.97 | $3.30 – $80.53 | 29 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $386.53 | $644.22 | $56.30 – $579.80 | 29 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $161.61 | $269.35 | $10.81 – $242.41 | 29 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $41.28 | $68.80 | $3.29 – $61.92 | 29 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $49.20 | $82.00 | $0.40 – $17.64 | 23 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $3,598.55 | $5,997.58 | $10.73 – $5,397.82 | 29 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $202.98 | $338.30 | $8.47 – $44.59 | 29 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $316.50 | $527.50 | $8.19 – $44.45 | 29 |
| Gonioscopy CPT 92020 | $152.50 | $254.17 | $38.13 – $316.45 | 29 |
| Goniotomy CPT 65820 | $4,632.84 | $7,721.40 | $71.00 – $10,072.14 | 29 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $5,010.53 | $8,350.89 | $446.77 – $2,680.61 | 23 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $4,733.71 | $7,889.52 | $25.48 – $186.89 | 28 |
| Graft axiofill 1000mg HCPCS J3590 | $3,591.00 | $5,985.00 | $0.01 – $0.06 | 22 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $388.13 | $646.89 | $37.48 – $224.89 | 28 |
| Graft hand or finger tendon CPT 26416 | $2,777.50 | $4,629.16 | $71.00 – $8,018.48 | 29 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $27,603.28 | $46,005.47 | $10.85 – $186.89 | 28 |
| Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm HCPCS Q4113 | $1,585.80 | $2,643.00 | $396.45 – $2,378.70 | 22 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $20,782.10 | $34,636.83 | $100.87 – $605.22 | 20 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $50,985.00 | $84,975.00 | $10.57 – $63.42 | 20 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $141.58 | $235.96 | $35.39 – $212.36 | 28 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $1,315.71 | $2,192.85 | $76.02 – $456.11 | 28 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $765.06 | $1,275.10 | $46.95 – $281.70 | 28 |
| 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 | $10.72 – $186.89 | 28 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $4,742.40 | $7,904.00 | $4.56 – $186.89 | 28 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $800.41 | $1,334.02 | $58.73 – $352.40 | 28 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $50,985.00 | $84,975.00 | $24.18 – $145.11 | 20 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $3,670.92 | $6,118.20 | $3.88 – $23.30 | 20 |
| Granulocyte pheresis ea unit HCPCS P9050 | $4,337.60 | $7,229.33 | $1,084.40 – $6,506.40 | 22 |
| Great toe with reduction 28495 CPT 28495 | $577.03 | $961.72 | $71.00 – $865.55 | 29 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | not published | not published | $709.01 – $8,649.00 | 15 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | $5,102.99 | $8,504.99 | $71.00 – $8,887.48 | 29 |
| Grfg autol fat lipo ea addl CPT 15772 | not published | not published | $2,959.00 – $7,441.00 | 2 |
| Grfg autol soft tiss dir exc CPT 15769 | not published | not published | $1,457.62 – $8,887.48 | 15 |
| Ground mileage HCPCS A0425 | $3.74 | $6.24 | $0.68 – $4.05 | 22 |
| Group behave couns 2-10 HCPCS G0473 | $106.94 | $178.24 | $26.74 – $160.42 | 29 |
| Group health education CPT 99078 | $76.66 | $127.76 | $19.16 – $114.98 | 22 |
| Group mnt 2 or more 30 mins HCPCS G0271 | $54.10 | $90.17 | $13.53 – $81.15 | 22 |
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.