Supplies, drugs & other prices at Baylor University Medical Center (Baylor Scott & White)

Dallas, TX · every code in this section with a posted price and a Medicare benchmark.

179 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
Ablation b9 thyroid nodule perq laser w/img gdn (0673T) $1,724.39 $2,873.98 1.0×
Ablation mal brst tumor perq crtx unilateral (0581T) $3,604.51 $6,007.52 0.9×
Abltj perc cryoabltj img gdn lxtr/perph nerve (0441T) $2,157.02 $3,595.04 1.1×
Abltj perc cryoabltj img gdn nrv plex/trncl nrv (0442T) $7,414.38 $12,357.30 0.8×
Abltj perc cryoabltj img gdn uxtr/perph nerve (0440T) $2,157.02 $3,595.04 1.1×
Adm of soc dtr assess 5-15 m (G0136) $32.81 $54.68 0.9×
Adm tocilizu covid-19 1st (M0249) $540 $900 1.2×
Adm tocilizu covid-19 2nd (M0250) $540 $900 1.2×
Admin hepatitis b vaccine (G0010) $66.97 $111.62 1.4×
Admin influenza virus vac (G0008) $15 $25 0.3×
Admin pneumococcal vaccine (G0009) $42.50 $70.83 0.9×
Automated analysis of binocular eye movements without spatial calibration, including disconjugacy, saccades, and… (0615T) $130.84 $218.06 1.0×
Blind interatrial shunt ide (C9758) $14,874 $24,790 0.9×
Body surface-activation mapping of pacemaker or pacing cardioverter-defibrillator lead(s) to optimize electrical… (0696T) $45.64 $76.06 1.2×
Ca screen;pelvic/breast exam (G0101) $94.61 $157.69 0.9×
Catheterize for urine spec (P9612) $88 $146.66 9.4×
Colonic lavage, 35 or more liters of water, gravity-fed, with induced defecation, including insertion of rectal catheter (0736T) $175.14 $291.90 1.4×
Colonoscopy, flexible, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by… (0885T) $5,779.28 $9,632.14 0.9×
Colorectal scrn; hi risk ind (G0105) $2,265.62 $3,776.04 2.4×
Complete occlusal adjustment (D9952) $510.23 $850.38 0.8×
Covid-19 lab test non-cdc (U0002) $54 $90 1.1×
Crown porcelain w/ h noble m (D2750) $900 $1,500 1.4×
Cysto impl 4 or more (C9740) $6,571.50 $10,952.50 0.7×
Cystoscopy prostatic imp 1-3 (C9739) $5,741.40 $9,569 1.1×
Dental prophylaxis adult (D1110) $66 $110 0.5×
Direct refer hospital observ (G0379) $577.43 $962.38 1.0×
Drug metabolism (adverse drug reactions and drug response), targeted sequence analysis (ie, CYP1A2, CYP2C19, CYP2C9,… (0029U) $750 $1,250 1.0×
Drug test def 1-7 classes (G0480) $141.09 $235.15 1.2×
Drug test def 22+ classes (G0483) $458.06 $763.43 1.9×
Ekg tracing for initial prev (G0404) $82.25 $137.08 2.8×
Electrophysiologic eval icds w/ss electrode (0577T) $1,310.28 $2,183.80 1.1×
End thxpy, molar tooth (D3330) $452.09 $753.48 0.7×
End thxpy, premolar tooth (D3320) $376.74 $627.90 0.6×
Endo outlet restrict w/tube (C9785) $11,332.91 $18,888.18 1.1×
Ephys eval ccm-d ld 1st impl (0930T) $1,391.76 $2,319.60 1.1×
Ephys eval ccm-d ld separate (0931T) $1,391.76 $2,319.60 1.1×
Esophagoscopy, flexible, transoral, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon)… (0884T) $5,749.64 $9,582.74 0.9×
Ev fempop artl revsc tcat plmt IV st grf & clsr (0505T) $18,167.65 $30,279.42 1.6×
Evasc ven artlz tibl/prnl vn (0620T) $31,776.94 $52,961.56 0.7×
Extraction erupted tooth/exr (D7140) $454.74 $757.90 0.7×
Fecal blood scrn immunoassay (G0328) $38.05 $63.41 2.1×
Fecal microbiota prep instil (G0455) $897.47 $1,495.78 1.0×
FLT3 (fms-related tyrosine kinase 3) (eg, acute lyeloid leukemia) internal tandem duplication (ITD) variants,… (0046U) $3,382.50 $5,637.50 8.3×
Full mouth debridement (D4355) $325.26 $542.10 0.5×
Hbot, full body chamber, 30m (G0277) $746.99 $1,244.99 5.4×
Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant hepatocellular tissue, including image… (0686T) $15,000.60 $25,001 0.9×
Home sleep test/type 3 porta (G0399) $658.80 $1,098 3.0×
Hopd mntl hlt, 15-29 min (C7900) $95.47 $159.11 2.5×
Hopd mntl hlt, 30-60 min (C7901) $190.92 $318.20 1.9×
Hospital outpt clinic visit (G0463) $195 $325 1.5×
Impact tooth remov comp bony (D7240) $740.90 $1,234.83 1.1×
Impact tooth remov part bony (D7230) $656.56 $1,094.27 1.0×
Impact tooth remov soft tiss (D7220) $460.34 $767.24 0.7×
Init/sub psych care m 1st 30 (G2214) $89.84 $149.74 0.9×
Initial preventive exam (G0402) $178.57 $297.62 1.3×
Inj for sacroiliac jt anesth (G0260) $1,464.93 $2,441.55 2.1×
Injection, posterior chamber of eye, medication (0699T) $2,545.03 $4,241.72 1.1×
Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic… (0915T) $36,756.42 $61,260.70 1.2×
Insertion of substernal implantable defibrillator electrode (0572T) $9,537.90 $15,896.50 1.1×
Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming,… (0517T) $10,298.86 $17,164.76 1.0×
Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when… (0410T) $15,200.18 $25,333.64 1.8×
Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when… (0409T) $16,497.14 $27,495.24 0.7×
Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when… (0411T) $11,913.31 $19,855.52 1.4×
Insj wcs lv compl sys (0515T) $33,617.19 $56,028.65 1.5×
Insj wcs lv eltrd only (0516T) $11,328.74 $18,881.24 1.1×
Insj/rplc car modulj sys pls gen transvns eltrd (0408T) $43,820.09 $73,033.49 1.4×
Insj/rplcmt icds w/substernal electrode (0571T) $39,354.04 $65,590.06 1.2×
Instlj fecal microbiota ssp rct nma lwr gi trc (0780T) $147.78 $246.30 1.1×
Interrog dev eval impl ccm-d system in person (0927T) $42.76 $71.26 1.1×
Interrogation device evaluation (in person) of implantable cardioverter-defibrillator system with substernal electrode,… (0576T) $41.52 $69.20 1.1×
Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and… (0418T) $268.88 $448.14 7.2×
Ire ablation 1+tumors per organ w/img gdn perq (0600T) $10,915.75 $18,192.92 1.0×
JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis, targeted sequence analysis exons 12-15 Other… (0027U) $514.34 $857.24 4.2×
Limit oral eval problm focus (D0140) $36 $60 0.3×
Limited occlusal adjustment (D9951) $300.73 $501.21 0.5×
Liver disease, ten biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, haptoglobin,… (0003M) $754.50 $1,257.50 1.5×
Localized delivery antimicro (D4381) $510.23 $850.38 0.8×
Mra w/cont, lwr ext (C8912) $1,691.95 $2,819.92 4.8×
Mra w/o cont, lwr ext (C8913) $1,691.95 $2,819.92 7.1×
Mra w/o fol w/cont, lwr ext (C8914) $1,965.82 $3,276.37 5.6×
Mra, w/dye, spinal canal (C8931) $1,033.39 $1,722.32 2.9×
Mra, w/o dye, spinal canal (C8932) $1,033.39 $1,722.32 4.3×
Mra, w/o&w/dye, spinal canal (C8933) $1,590.76 $2,651.26 4.5×
Mri w/cont, breast, bi (C8906) $1,994.42 $3,324.03 5.7×
Mri w/cont, breast, uni (C8903) $2,039.11 $3,398.51 11.6×
Mri w/o fol w/cont, breast, (C8908) $2,056.69 $3,427.81 5.9×
Mri w/o fol w/cont, brst, un (C8905) $1,938.60 $3,231 5.5×
Neuro csf prion prtn qual (0035U) $939.11 $1,565.19 1.7×
Njx bone sub matrl into subchondral bone defect (0707T) $3,470.74 $5,784.56 1.1×
Njx pltlt plasma w/img harvest/preparation (0232T) $1,149 $1,915 2.6×
Oncology (Merkel cell-carcinoma), detection of antibodies to the Merkel cell polyoma virus oncoprotein (small T… (0058U) $504.48 $840.79 1.6×
Oth resp proc, group (G0239) $180.44 $300.74 4.8×
Oth resp proc, indiv (G0238) $124.57 $207.61 4.3×
Pathogen test for platelets (P9100) $29.90 $49.84 0.5×
Pattern electroretinography w/i&r (0509T) $585 $975 2.7×
Pelvic ring fracture uni/bil (G0413)
unusually low — confirm this is the full procedure
$3,091.54 $5,152.56 0.4×
Pemivibart infusion (M0224) $520.56 $867.60 1.2×
Perc d-e cor revasc chro sin (C9607) $23,183.31 $38,638.85 1.3×
Perc d-e cor revasc t cabg s (C9604) $21,790.26 $36,317.10 1.9×
Perc d-e cor stent ather s (C9602) $25,517.04 $42,528.40 1.4×
Perc drug-el cor stent sing (C9600) $22,555.52 $37,592.54 1.9×
Periodic oral evaluation (D0120) $36 $60 0.3×
Periodontal scaling & root (D4341) $72 $120 0.1×
Perq sac agmntj bi w/wo balo/mchnl dev 2/> ndls (0201T) $6,588.81 $10,981.35 0.9×
Perq sac agmntj uni w/wo balo/mchnl dev 1/> ndl (0200T) $5,362.78 $8,937.97 0.7×
Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) $6,536.40 $10,894 0.6×
Place device/marker, non pro (C9728) $1,465.75 $2,442.91 1.1×
Place direct restoration (D2940) $63 $105 0.1×
Post 1 srfc resinbased cmpst (D2391) $72 $120 0.1×
Post 2 srfc resinbased cmpst (D2392) $84 $140 0.1×
Post 3 srfc resinbased cmpst (D2393) $96 $160 0.1×
Pre-op service lvrs 1-9 dos (G0304) $2,062.26 $3,437.10 5.5×
Pre-op service lvrs 10-15dos (G0303) $3,907.86 $6,513.10 18.0×
Prgrmg device evaluation cardiac modulj system (0417T) $232.04 $386.73 6.2×
Programming device eval impl ccm-d sys in person (0926T) $42.76 $71.26 1.1×
Programming device evaluation (in person) of implantable cardioverter-defibrillator system with substernal electrode,… (0575T) $41.52 $69.20 1.1×
Programming device evaluation (in person) with iterative adjustment of implantable device to test the function of… (0804T) $41.52 $69.20 1.1×
Prostate biopsy, any mthd (G0416) $568.61 $947.69 1.6×
Provide inr test mater/equip (G0249) $151.14 $251.90 1.1×
Psa screening (G0103) $136.61 $227.69 7.1×
Pulp cap direct (D3110) $347.76 $579.60 0.5×
Quan mr alys tis compj wo MRI same sess mlt orgn (0697T) $802.18 $1,336.96 0.9×
Quan mr alys tiss composition w/MRI mlt organs (0698T) $1,089.68 $1,816.14 1.2×
Quan mr tiss w/MRI 1orgn (0649T) $1,140.60 $1,901 1.2×
Quan us tiss charac i&r w/o dx us same anat (0689T) $109.04 $181.74 1.2×
Re-cement or re-bond crown (D2920) $36 $60 0.1×
Real-time fluorescence wound imaging with clinical darkness, to identify location of bacterial wound pathogens and… (0598T) $357 $595 1.6×
Red blood cell antigen typing, DNA, genotyping of 10 blood groups with phenotype pdediction of 37 red blood cell… (0084U) $403.50 $672.50 0.6×
Red blood cell antigen typing, DNA, human erythrocyte antigen gene analysis of 35 antigens from 11 blood groups,… (0001U) $387.31 $645.51 0.5×
Reloc skin pocket pls gen (0416T) $3,792.46 $6,320.77 1.8×
Rem imp tooth w mucoper flp (D7210) $451.10 $751.84 0.3×
Remote interrog dev eval ccm-d sys <90d tech (0929T) $42.76 $71.26 1.1×
Removal and replacement of permanent cardiac contractility modulation system pulse generator only (0414T)
unusually low — confirm this is the full procedure
$9,736.30 $16,227.17 0.4×
Removal and replacement of pulse generator for wireless cardiac stimulator for left ventricular pacing, including… (0519T)
unusually low — confirm this is the full procedure
$4,421.77 $7,369.61 0.4×
Removal and replacement of pulse generator for wireless cardiac stimulator for left ventricular pacing, including… (0520T) $26,949.80 $44,916.34 2.6×
Removal of permanent cardiac contractility modulation system; pulse generator only (0412T) $5,634.53 $9,390.88 1.5×
Removal of permanent cardiac contractility modulation system; transvenous electrode (atrial or ventricular) (0413T) $1,108.20 $1,847 0.3×
Removal of pulse generator components of wireless heart stimulator system for pacing of lower left chamber of heart (0518T) $3,517.86 $5,863.10 0.9×
Removal of substernal implantable defibrillator pulse generator only (0580T) $4,323.46 $7,205.76 1.2×
Repos prev impl ss impltbl dfb pacing eltrd (0574T) $3,915.44 $6,525.74 1.0×
Repositioning of previously implanted cardiac contractility modulation transvenous electrode (atrial or ventricular… (0415T) $5,032.38 $8,387.30 8.0×
Resin 4/> surf or w incis an (D2335) $120 $200 0.2×
Resin one surface-anterior (D2330) $72 $120 0.1×
Resin three surfaces-anterio (D2332) $96 $160 0.1×
Resin two surfaces-anterior (D2331) $84 $140 0.1×
Revasc intra lithotrip-ather (C9766) $26,669.14 $44,448.56 1.4×
Revasc intra lithotrip-stent (C9765) $26,279.32 $43,798.86 1.4×
Revasc intravasc lithotripsy (C9764) $17,577.62 $29,296.04 1.5×
Revasc lith-sten-ath tib/per (C9775) $18,789.86 $31,316.44 1.0×
Revasc lithotr-ather tib/per (C9774) $21,307.71 $35,512.85 1.2×
Revasc lithotr-stent tib/per (C9773) $22,322.36 $37,203.94 1.2×
Revasc lithotrip tibi/perone (C9772) $14,653.34 $24,422.24 1.3×
Revasc lithotrip-stent-ather (C9767) $47,090.87 $78,484.79 2.6×
Rmvl substernal implantable defibrillator eltrd (0573T) $3,915.44 $6,525.74 1.0×
Rmvl&rplcmt substernal impltbl defibrillator pg (0614T) $26,949.80 $44,916.34 1.2×
Sigmoidoscopy, flexible, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by… (0886T) $5,779.28 $9,632.14 0.9×
Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) $21,452.34 $35,753.90 1.1×
Tcat insj perm 2chmbr ldls pm r atr pm compnt (0796T) $21,863.78 $36,439.64 1.1×
Tcat insj perm dual chamber ldls pm compl sys (0795T) $21,452.34 $35,753.90 1.1×
Tcat rmvl perm dual chamber ldls pm compl sys (0798T) $3,608.40 $6,014 1.1×
Tcat rmvl&rplcmt perm 2chmbr ldls pm 2chmbr sys (0801T) $21,452.34 $35,753.90 1.1×
Tcat rmvl/debulk icar mass suction device perq (0644T) $6,822.19 $11,370.31 1.2×
Therapeutic procd strg endur (G0237) $132.74 $221.24 4.6×
Therapeutic ultrafiltration (0692T) $3,148.74 $5,247.90 2.0×
Tooth root removal (D7250) $452.59 $754.32 0.7×
Tpmt nudt15 genes (0034U) $650.76 $1,084.60 1.4×
Transcatheter renal sympathetic denervation, percutaneous approach including arterial puncture, selective catheter… (0339T) $13,714.83 $22,858.05 2.4×
Transperineal focal laser ablation of malignant prostate tissue, including transrectal imaging guidance, with MR-fused… (0655T) $3,724.85 $6,208.08 0.7×
Trauma respons w/hosp criti (G0390) $4,728.65 $7,881.09 3.5×
Trgt gen seq DNA 324 genes (0037U) $3,885 $6,475 1.1×
Trluml perip athrc abd aorta (0236T) $7,099.63 $11,832.71 0.6×
Trluml perip athrc iliac art (0238T) $18,649.53 $31,082.55 1.0×
Trnscth renal symp denrv unl (0338T) $5,075.50 $8,459.16 0.9×
Tte w or w/o contr, cont ecg (C8930) $2,198.34 $3,663.90 2.8×
Unsched dialysis esrd pt hos (G0257) $1,807.06 $3,011.77 2.6×
Vasc emb/occ w/prs cath (C9797) $14,870.87 $24,784.78 0.8×
Visit esketamine 56m or less (G2082) $780.60 $1,301 0.8×
Visit esketamine, > 56m (G2083) $1,109.94 $1,849.90 0.7×
Visit to determ ldct elig (G0296) $98.14 $163.56 1.0×