Supplies, drugs & other prices at Baylor Scott & White Medical Center - Centennial
Frisco, TX · every code in this section with a posted price and a Medicare benchmark.
192 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Ablation b9 thyroid nodule perq laser w/img gdn (0673T) | $1,724.39 | $2,873.98 | 1.0× |
| Ablation, malignant breast tumor(s), percutaneous, cryotherapy, including imaging guidance when performed, 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× |
| Bdy surf activation mapg pm/cvdfb leads tm f/up (0696T) | $45.64 | $76.06 | 1.2× |
| Blind interatrial shunt ide (C9758) | $14,874 | $24,790 | 0.9× |
| Ca screen;pelvic/breast exam (G0101) | $94.61 | $157.69 | 0.9× |
| Catheterize for urine spec (P9612) | $95.03 | $158.39 | 10.2× |
| 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× |
| Colorectal scrn; hi risk ind (G0105) | $2,265.62 | $3,776.04 | 2.4× |
| Colsc flx trnsorl 1st tndsc dilat rx balo cath (0885T) | $5,779.28 | $9,632.14 | 0.9× |
| Complete occlusal adjustment (D9952) | $510.23 | $850.38 | 0.8× |
| Comt gene analysis c.472g>a variant (0032U) | $1,011 | $1,685 | 5.8× |
| Covid-19 lab test non-cdc (U0002) | $58.32 | $97.20 | 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× |
| Diab manage trn per indiv (G0108) | $100.98 | $168.30 | 1.8× |
| Diab manage trn ind/group (G0109) | $59.36 | $98.94 | 3.7× |
| Direct refer hospital observ (G0379) | $554.33 | $923.88 | 0.9× |
| Drug test def 1-7 classes (G0480) range across 30 matching MRF lines |
$68.66–$346.50 | $114.43–$577.50 | varies |
| Drug test def 15-21 classes (G0482) | $203.97 | $339.95 | 1.0× |
| Drug test def 22+ classes (G0483) | $479.60 | $799.33 | 1.9× |
| Ekg tracing for initial prev (G0404) | $82.25 | $137.08 | 2.8× |
| Elec stim other than wound (G0283) | $87.34 | $145.56 | 6.9× |
| Elec stim unattend for press (G0281) | $165.31 | $275.52 | 14.1× |
| Electrophysiologic eval ccm-d leads at 1st impl (0930T) | $1,391.76 | $2,319.60 | 1.1× |
| Electrophysiologic eval ccm-d leads separate (0931T) | $1,391.76 | $2,319.60 | 1.1× |
| 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× |
| Endovascular Venous Arterialization Tibl/Prnl Vn (0620T) | $31,776.94 | $52,961.56 | 0.7× |
| 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) | $19,621.06 | $32,701.77 | 1.7× |
| Extraction erupted tooth/exr (D7140) | $454.74 | $757.90 | 0.7× |
| Eye mvmt analysis w/o spatial calibration i&r (0615T) | $130.84 | $218.06 | 1.0× |
| Fecal blood scrn immunoassay (G0328) | $41.09 | $68.48 | 2.3× |
| Fecal microbiota prep instil (G0455) | $897.47 | $1,495.78 | 1.0× |
| Flt3 gene int tandem dupl variants quantitative (0046U) | $3,382.50 | $5,637.50 | 8.3× |
| Full mouth debridement (D4355) | $325.26 | $542.10 | 0.5× |
| Group mnt 2 or more 30 mins (G0271) | $66.55 | $110.92 | 3.9× |
| Hbot, full body chamber, 30m (G0277) | $717.11 | $1,195.19 | 5.2× |
| Histotripsy mal hepatocellular tiss w/img gdn (0686T) | $15,000.60 | $25,001 | 0.9× |
| Hiv combination assay (G0475) | $28.90 | $48.16 | 1.2× |
| Home sleep test/type 3 porta (G0399) | $658.80 | $1,098 | 3.0× |
| Hopd mntl hlt, 15-29 min (C7900) | $103.10 | $171.84 | 2.7× |
| Hopd mntl hlt, 30-60 min (C7901) | $206.20 | $343.66 | 2.0× |
| Hospital outpt clinic visit (G0463) range across 19 matching MRF lines |
$112.68–$195 | $187.80–$325 | varies |
| 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) | $1,582.12 | $2,636.87 | 2.2× |
| Injection posterior chamber eye medication (0699T) | $2,545.03 | $4,241.72 | 1.1× |
| Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that… (0216T) | $901.34 | $1,502.24 | 1.0× |
| Insertion of substernal implantable defibrillator electrode (0572T) | $9,537.90 | $15,896.50 | 1.1× |
| Insertion wrls car stimulator lv pacg compl sys (0515T) | $33,617.19 | $56,028.65 | 1.5× |
| Insj perm ccm-d sys pg&dual transvns eltrds/lds (0915T) | $36,756.42 | $61,260.70 | 1.2× |
| Insj Wcs Lv Eltrd Only (0516T) | $11,328.74 | $18,881.24 | 1.1× |
| Insj Wcs Lv Pg Compnt (0517T) | $10,298.86 | $17,164.76 | 1.0× |
| Insj/Rplc Car Modulj Sys Pls Gen Transvns Eltrd (0408T) | $47,325.70 | $78,876.17 | 1.5× |
| Insj/Rplc Car Modulj Sys Ventr Electrode Only (0411T) | $11,913.31 | $19,855.52 | 1.4× |
| Insj/Rplc Cardiac Modulj Sys Atr Electrode Only (0410T) | $15,200.18 | $25,333.64 | 1.8× |
| Insj/Rplc Cardiac Modulj Sys Pls Generator Only (0409T) | $16,497.14 | $27,495.24 | 0.7× |
| Insj/Rplcmt Icds W/Substernal Electrode (0571T) | $39,354.04 | $65,590.06 | 1.2× |
| Instlj fecal microbiota ssp (0780T) | $147.78 | $246.30 | 1.1× |
| Interro Device Evaluation Cardiac Modulj System (0418T) | $290.39 | $483.99 | 7.7× |
| Interrog dev eval impl ccm-d system in person (0927T) | $42.76 | $71.26 | 1.1× |
| Interrogation Dev Eval Icds W/Ss Eltrd In Person (0576T) | $41.52 | $69.20 | 1.1× |
| Ire Abltj 1+Tum Organ Perq (0600T) | $10,915.75 | $18,192.92 | 1.0× |
| Jak2 Gene Analysis Trgt Seq Alys Exons 12-15 (0027U) range across 2 matching MRF lines |
$481.34–$547.35 | $802.23–$912.25 | varies |
| Limit oral eval problm focus (D0140) | $36 | $60 | 0.3× |
| Limited occlusal adjustment (D9951) | $300.73 | $501.21 | 0.5× |
| Liver Dis 10 Assays Serum Algorithm W/Nash (0003M) | $754.50 | $1,257.50 | 1.5× |
| Localized delivery antimicro (D4381) | $510.23 | $850.38 | 0.8× |
| Mnt subs tx for change dx (G0270) | $57.53 | $95.88 | 1.8× |
| 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× |
| Ncntc R-T Fluor Wnd Img 1st (0598T) | $357 | $595 | 1.6× |
| Neuro csf prion prtn qual (0035U) | $1,014.25 | $1,690.41 | 1.9× |
| Njx bone sub matrl into subchondral bone defect (0707T) | $3,470.74 | $5,784.56 | 1.1× |
| Njx platelet plasma (0232T) | $1,149 | $1,915 | 2.6× |
| Onc Merkel Cll Carc Srm Quan (0058U) range across 2 matching MRF lines |
$496.88–$512.07 | $828.13–$853.45 | varies |
| Oth resp proc, group (G0239) | $173.23 | $288.71 | 4.6× |
| Oth resp proc, indiv (G0238) | $119.59 | $199.31 | 4.1× |
| Pathogen test for platelets (P9100) | $29.90 | $49.84 | 0.5× |
| Pattern erg 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) range across 3 matching MRF lines |
$23,183.31–$25,041.46 | $38,638.85–$41,735.77 | varies |
| 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) | $26,512.47 | $44,187.45 | 1.4× |
| Perc drug-el cor stent sing (C9600) range across 6 matching MRF lines |
$22,555.52–$23,831.01 | $37,592.54–$39,718.35 | varies |
| Periodic oral evaluation (D0120) | $36 | $60 | 0.3× |
| Periodontal scaling & root (D4341) | $72 | $120 | 0.1× |
| Perq Sacral Augmt Bilat Inj (0201T) | $7,115.92 | $11,859.86 | 1.0× |
| Perq Sacral Augmt Unilat Inj (0200T) | $5,791.81 | $9,653.01 | 0.8× |
| 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) | $1,583 | $2,638.34 | 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 dev eval ldls pm sys 2chmbr in person (0804T) | $41.52 | $69.20 | 1.1× |
| Prgrmg Device Evaluation Cardiac Modulj System (0417T) | $232.04 | $386.73 | 6.2× |
| Programming dev eval icds w/ss eltrd in person (0575T) | $41.52 | $69.20 | 1.1× |
| Programming device eval impl ccm-d sys in person (0926T) | $42.76 | $71.26 | 1.1× |
| Prostate biopsy, any mthd (G0416) | $614.11 | $1,023.51 | 1.7× |
| Provide inr test mater/equip (G0249) | $151.14 | $251.90 | 1.1× |
| Psa screening (G0103) | $147.55 | $245.91 | 7.6× |
| Pulp cap direct (D3110) | $347.76 | $579.60 | 0.5× |
| Quan mr alys tis compj wo MRI same sess mlt orgn (0697T) range across 2 matching MRF lines |
$282–$1,322.36 | $470–$2,203.93 | varies |
| Quan mr alys tiss composition w/MRI 1orgn (0649T) | $1,231.85 | $2,053.08 | 1.3× |
| Quan mr alys tiss composition w/MRI mlt organs (0698T) | $1,089.68 | $1,816.14 | 1.2× |
| Quan us tiss charac i&r w/o dx us same anat (0689T) | $117.77 | $196.28 | 1.3× |
| Rbc DNA gnotyp 10 bld groups (0084U) | $403.50 | $672.50 | 0.6× |
| Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) range across 2 matching MRF lines |
$360–$387.31 | $600–$645.51 | varies |
| Re-cement or re-bond crown (D2920) | $36 | $60 | 0.1× |
| Reloc Skin Pocket Cardiac Modulj Pulse Generator (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 Ss Dfb Electrode (0573T) | $3,915.44 | $6,525.74 | 1.0× |
| Repos Cardiac Modulj Transvenous Electrode (0415T) | $5,032.38 | $8,387.30 | 8.0× |
| Repos prev impl ss impltbl dfb pacing eltrd (0574T) | $3,915.44 | $6,525.74 | 1.0× |
| 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) | $28,802.66 | $48,004.44 | 1.6× |
| Revasc intra lithotrip-stent (C9765) | $26,279.32 | $43,798.86 | 1.4× |
| Revasc intravasc lithotripsy (C9764) | $16,874.52 | $28,124.20 | 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) | $50,858.14 | $84,763.57 | 2.8× |
| Rmvl & Rpl Cardiac Modulj Sys Pls Generator Only (0414T) unusually low: confirm this is the full procedure |
$9,736.30 | $16,227.17 | 0.4× |
| Rmvl & Rplcmt Pg Compnt Wcs (0519T) unusually low: confirm this is the full procedure |
$4,421.77 | $7,369.61 | 0.4× |
| Rmvl Car Modulj Tranvns Elt (0413T) | $1,108.20 | $1,847 | 0.3× |
| Rmvl Cardiac Modulj Pls Gen (0412T) | $5,634.53 | $9,390.88 | 1.5× |
| Rmvl Pg Compnt Wcs (0518T) | $3,517.86 | $5,863.10 | 0.9× |
| Rmvl Substernal Impltbl Dfb Pulse Generator Only (0580T) | $4,323.46 | $7,205.76 | 1.2× |
| Rmvl&Rplcmt Pg Wcs New Eltrd (0520T) | $26,949.80 | $44,916.34 | 2.6× |
| Rmvl&Rplcmt Substernal Impltbl Defibrillator Pg (0614T) | $26,949.80 | $44,916.34 | 1.2× |
| Rx Metab Advrs Trgt Seq Alys (0029U) | $750 | $1,250 | 1.0× |
| Sigmoidoscopy, flexible, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by… (0886T) | $5,779.28 | $9,632.14 | 0.9× |
| Sim ang w/prs cath rad emb (C8004) | $13,001.06 | $21,668.44 | 1.1× |
| 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 1chmbr ldls pm r atrial (0825T) | $21,863.78 | $36,439.64 | 1.1× |
| Tcat rmvl&rplcmt perm 2chmbr ldls pm 2chmbr sys (0801T) | $21,452.34 | $35,753.90 | 1.1× |
| Tcat rmvl&rplcmt perm 2chmbr ldls pm r atr cmpnt (0802T) | $21,863.78 | $36,439.64 | 1.1× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) | $6,822.19 | $11,370.31 | 1.2× |
| Therapeutic procd strg endur (G0237) | $143.36 | $238.94 | 4.9× |
| Therapeutic ultrafiltration (0692T) | $3,148.74 | $5,247.90 | 2.0× |
| Tooth root removal (D7250) | $452.59 | $754.32 | 0.7× |
| Tpmt and Nudt15 Genotype (0034U) range across 2 matching MRF lines |
$650.76–$666 | $1,084.60–$1,110 | varies |
| Transcatheter Renal Sympath Denervation Bilat (0339T) | $13,714.83 | $22,858.05 | 2.4× |
| Transcatheter renal sympath denervation unilat (0338T) | $5,075.50 | $8,459.16 | 0.9× |
| Transperineal focal laser abltj mal prst8 tiss (0655T) | $3,724.85 | $6,208.08 | 0.7× |
| Trauma respons w/hosp criti (G0390) range across 11 matching MRF lines |
$591.43–$8,026.96 | $985.71–$13,378.27 | varies |
| Trgt gen seq alys sld orgn neo DNA 324 genes (0037U) range across 2 matching MRF lines |
$2,520–$5,250 | $4,200–$8,750 | varies |
| 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× |
| Tte w or w/o contr, cont ecg (C8930) | $2,198.34 | $3,663.90 | 2.8× |
| Unsched dialysis esrd pt hos (G0257) | $1,951.63 | $3,252.71 | 2.8× |
| Vasc emb/occ w/prs cath (C9797) | $16,060.54 | $26,767.56 | 0.9× |
| 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× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.