Supplies, drugs & other prices at Medical City Alliance

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

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

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ProcedureCash priceGross charge× Medicare
2d tee w or w/o fol w/con,in (C8925) $8,861.30 $8,861.30 11.2×
2d tte w or w/o fol w/con,co (C8923) $8,861.30 $8,861.30 11.2×
2d tte w or w/o fol w/con,fu (C8924) $6,427.62 $6,427.62 18.3×
Adm tocilizu covid-19 1st (M0249) $760.69 $760.69 1.7×
Adm tocilizu covid-19 2nd (M0250) $760.69 $760.69 1.7×
Admin hepatitis b vaccine (G0010) $227.13 $227.13 4.8×
Admin influenza virus vac (G0008) $140.39 $140.39 3.0×
Admin pneumococcal vaccine (G0009) $140.39 $140.39 3.0×
Colon ca scrn not hi rsk ind (G0121) $3,658.14 $3,658.14 3.9×
Colorectal scrn; hi risk ind (G0105) $7,112.47 $7,112.47 7.6×
Direct refer hospital observ (G0379) $1,218.17 $1,218.17 2.0×
Drug test def 1-7 classes (G0480) $1,311.78 $1,311.78 11.5×
Drug test def 15-21 classes (G0482) $1,443.81 $1,443.81 7.3×
Drug test def 22+ classes (G0483) $1,584.42 $1,584.42 6.4×
Drug test def 8-14 classes (G0481) $1,742.17 $1,742.17 11.1×
Elec stim other than wound (G0283) $461.63 $461.63 36.4×
Elec stim unattend for press (G0281) $461.63 $461.63 39.5×
Lev 1 hosp type b ed visit (G0380) $1,478.97 $1,478.97 19.8×
Lev 2 hosp type b ed visit (G0381) $1,782.77 $1,782.77 19.1×
Lev 3 hosp type b ed visit (G0382) $3,386.92 $3,386.92 19.6×
Lev 4 hosp type b ed visit (G0383) $5,349.97 $5,349.97 20.1×
Lev 5 hosp type b ed visit (G0384) $7,728.68 $7,728.68 18.7×
Mra w/cont, abd (C8900) $7,181.77 $7,181.77 20.5×
Mra w/cont, chest (C8909) $7,181.77 $7,181.77 20.5×
Mra w/cont, lwr ext (C8912) $9,156.67 $9,156.67 26.1×
Mra w/o cont, abd (C8901) $5,641.37 $5,641.37 23.5×
Mra w/o cont, chest (C8910) $7,038.76 $7,038.76 29.3×
Mra w/o cont, lwr ext (C8913) $5,683.59 $5,683.59 23.7×
Mra w/o fol w/cont, abd (C8902) $7,147.72 $7,147.72 20.4×
Mra w/o fol w/cont, chest (C8911) $6,961.13 $6,961.13 19.8×
Mra w/o fol w/cont, lwr ext (C8914) $8,842.05 $8,842.05 25.2×
Mra w/o fol w/cont, pelvis (C8920) $4,234.42 $4,234.42 12.1×
Mra, w/o&w/dye, upper extr (C8936) $4,234.42 $4,234.42 12.1×
Mri w/cont, breast, uni (C8903) $1,675.24 $1,675.24 9.5×
Mri w/o fol w/cont, breast, (C8908) $5,712.19 $5,712.19 16.3×
Mri w/o fol w/cont, brst, un (C8905) $5,503.80 $5,503.80 15.7×
Pathogen test for platelets (P9100) $395.35 $395.35 6.7×
Perc d-e cor revasc chro sin (C9607) $53,716.47 $53,716.47 2.9×
Perc d-e cor revasc t cabg s (C9604) $53,716.47 $53,716.47 4.6×
Perc d-e cor stent ather s (C9602) $48,461.70 $48,461.70 2.6×
Perc drug-el cor stent sing (C9600) $53,716.47 $53,716.47 4.6×
Psa screening (G0103) $1,207.17 $1,207.17 62.5×
Revasc intra lithotrip-ather (C9766) $87,375.93 $87,375.93 4.7×
Revasc intra lithotrip-stent (C9765) $80,486.12 $80,486.12 4.4×
Revasc intravasc lithotripsy (C9764) $47,246.54 $47,246.54 4.1×
Revasc lithotrip tibi/perone (C9772) $64,724 $64,724 5.6×
Revasc lithotrip-stent-ather (C9767) $76,453.94 $76,453.94 4.1×
Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) $20,953.08 $20,953.08 3.7×
Tomosynthesis, mammo (G0279) $251.97 $251.97 19.9×
Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation;… (0236T) $100,847.68 $100,847.68 8.7×
Trauma respons w/hosp criti (G0390) $24,489 $24,489 18.3×
Trluml Perip Athrc Renal Art (0234T) $104,283.76 $104,283.76 9.0×
Trluml periph athrc w/rs&i brchiocphl ea vsl (0237T) $100,847.68 $100,847.68 8.7×
Tte w or wo fol wcon,doppler (C8929) $8,861.30 $8,861.30 11.2×
Unsched dialysis esrd pt hos (G0257) $6,113.12 $6,113.12 8.9×