North Texas Medical Center - Price List for Shoppable Services

Prices Posted and Effective as of 12-29-2020

Disclaimer: To help patients understand what their potential financial liability for services might be, North Texas Medical Center will provide standard prices for services. If you would like information about charges, please call our Patient Financial Service Department at (940) 612-8660 and speak with the Financial Counselor to request an estimated price. Our price lists will be updated at least annually or more frequently if pricing changes.

The hospital’s charges are the same for all patients, but a patient’s responsibility may vary, depending on the discounts negotiated with individual health insurers. These price lists do not include these discounts. If you have health insurance, you should contact your insurance company directly to understand what your financial obligation will be. Uninsured or underinsured patients should consult with our Financial Assistant Representative at (940) 612-8389 to determine whether they qualify for discounts.

Also, the price lists do not include physicians’ fees from emergency physicians, surgeons, anesthesiologists, radiologists, pathologists or other professional fees. Your physician’s office will bill you separately for services and should be able to give you pricing information if you call their office directly. Prices also do not include charges for anesthesia, drugs, supplies, or additional testing, services or procedures ordered by your physician. Your final bill will vary depending on the actual services provided, existing health conditions that may impact your care (such as obesity, diabetes or smoking), and your insurance coverage, if you are insured.

Consumers can access a number of government and private websites, which provide additional information on hospitals’ charges and quality, through the internet. The American Hospital Association and your state Hospital Association may also have valuable information to help you understand healthcare pricing. The pricing provided is not an accurate reflection of actual patient cost. The pricing does not include insurance and other discounts that may be available. Contact us to request additional information.

Service DescriptionService CodeCash PriceRates
Service DescriptionService CodeCash PriceRates
CT Scan
CT scanCPT 70450$501
CT scan of abdomen and pelvis with contrastCPT 74177$631
CT scan of pelvis with contrastCPT 72193$63
Cardiovascular stress testCPT 93017$156
Heart/lung resuscitation cprCPT 92950$156
Initial new patient preventative medicine evaluation (18-3...CPT 99385$63
Initial new patient preventative medicine evaluation (40-6...CPT 99386$63
New patient office or other outpatient visit, 30 minCPT 99203$71
New patient office or other outpatient visit, 45 minCPT 99204$84
New patient office or other outpatient visit, 60 minCPT 99205$98
Patient office consultation, 40 min (Not Offered)CPT 99243--
Patient office consultation, 60 minCPT 99244$116
Sleep studyCPT 95810$2,463
Electrocardiogram tracingCPT 93005$78
Electrocardiogram, routine, with interpretation and reportCPT 93000$10
Emergency Room
Clear outer ear canalCPT 69200$87
Control of nosebleedCPT 30901$87
Critical care addl 30 minCPT 99292$197
Critical care first hourCPT 99291$788
Drainage of skin abscessCPT 10060$106
Dress/debrid p-thick burn sCPT 16020$97
Emergency dept visitCPT 99283$203
Emergency dept visitCPT 99284$268
Emergency dept visitCPT 99285$332
Emergency dept visitCPT 99282$135
Emergency dept visitCPT 99281$66
Insert bladder catheterCPT 51701$87
Insert emergency airwayCPT 31500$100
Insert temp bladder cathCPT 51702$87
Nervous system surgeryCPT 64999$159
Remove foreign body from eyeCPT 65205$66
Remove nasal foreign bodyCPT 30300$87
IV Therapy
Hydrate iv infusion add-onCPT 96361$39
Hydration iv infusion initCPT 96360$81
Ther/diag concurrent infCPT 96368$16
Ther/proph/diag inj iv pushCPT 96374$112
Ther/proph/diag inj sc/imCPT 96372$44
Ther/proph/diag iv inf addonCPT 96366$22
Ther/proph/diag iv inf initCPT 96365$114
Tx/pro/dx inj new drug addonCPT 96375$38
Tx/pro/dx inj same drug adonCPT 96376$36
Tx/proph/dg addl seq iv infCPT 96367$35
Abdomial ultrasound of pregnant uterusCPT 76805$172
Fetal biophys profil w/o nstCPT 76819$164
Mammography of both breastsCPT 77066$56
Mammography of one breastCPT 77065$44
Mammography, screening, bilateralCPT 77067$34
Perq device breast 1st imagCPT 19281$220
Ultrasound breast completeCPT 76641$119
Ultrasound of abdomenCPT 76700$238
Ultrasound pelvis through vaginaCPT 76830$187
Umbilical artery echoCPT 76820$60
Inpatient Procedures
Cardiac valve or cardiothoracic procedure with cardiac cat... (Not Offered)DRG 216--
Cervical spinal fusion without CC or MCC (Not Offered)DRG 473--
Major joint replacement or reattachment of lower extremity... (Not Offered)DRG 470--
Spinal fusion except cervical without MCC (Not Offered)DRG 460--
Uterine and adnexa procedures for non-malignancy without C... (Not Offered)DRG 743--
Labor and Delivery
Circumcision w/regionl blockCPT 54150$672
Fetal non-stress testCPT 59025$166
Obstetrical careCPT 59410$1,181
Acute hepatitis panelCPT 80074$86
Agent nos assay w/opticCPT 87899$40
Allg spec ige crude xtrc eaCPT 86003$10
Antinuclear antibodiesCPT 86038$39
Assay carbamazepine totalCPT 80156$35
Assay dipropylacetic acd totCPT 80164$35
Assay glucose blood quantCPT 82947$16
Assay iga/igd/igg/igm eachCPT 82784$33
Assay of ammoniaCPT 82140$35
Assay of amylaseCPT 82150$31
Assay of blood osmolalityCPT 83930$21
Assay of blood pkuCPT 84030$33
Assay of blood/uric acidCPT 84550$38
Assay of calciumCPT 82330$25
Assay of calciumCPT 82310$26
Assay of ck (cpk)CPT 82550$35
Assay of copperCPT 82525$18
Assay of creatinineCPT 82565$20
Assay of digoxin totalCPT 80162$27
Assay of ferritinCPT 82728$25
Assay of fetal fibronectinCPT 82731$116
Assay of folic acid serumCPT 82746$40
Assay of free testosteroneCPT 84402$35
Assay of free thyroxineCPT 84439$44
Assay of ggtCPT 82977$22
Assay of gonadotropin (fsh)CPT 83001$34
Assay of gonadotropin (lh)CPT 83002$53
Assay of haptoglobin quantCPT 83010$19
Assay of homocystineCPT 83090$31
Assay of igeCPT 82785$33
Assay of insulinCPT 83525$25
Assay of ironCPT 83540$13
Assay of lactic acidCPT 83605$42
Assay of lipaseCPT 83690$31
Assay of lithiumCPT 80178$34
Assay of magnesiumCPT 83735$29
Assay of myoglobinCPT 83874$46
Assay of natriuretic peptideCPT 83880$74
Assay of parathormoneCPT 83970$74
Assay of phenytoin totalCPT 80185$27
Assay of phosphorusCPT 84100$30
Assay of prealbuminCPT 84134$23
Assay of prolactinCPT 84146$68
Assay of protein otherCPT 84157$49
Assay of protein urineCPT 84156$23
Assay of serum albuminCPT 82040$20
Assay of serum potassiumCPT 84132$20
Assay of sex hormone globulCPT 84270$40
Assay of tacrolimusCPT 80197$26
Assay of tobramycinCPT 80200$29
Assay of total estradiolCPT 82670$51
Assay of total testosteroneCPT 84403$47
Assay of total thyroxineCPT 84436$15
Assay of triglyceridesCPT 84478$38
Assay of urea nitrogenCPT 84520$20
Assay of urine creatinineCPT 82570$26
Assay of urine osmolalityCPT 83935$25
Assay of urine sodiumCPT 84300$7
Assay of vancomycinCPT 80202$43
Assay of vitamin aCPT 84590$38
Assay of vitamin b-1CPT 84425$31
Assay of vitamin b-6CPT 84207$41
Assay of vitamin eCPT 84446$38
Assay of vitamin kCPT 84597$51
Assay of zincCPT 84630$17
Assay test for blood fecalCPT 82274$57
Assay triiodothyronine (t3)CPT 84480$40
Automated platelet countCPT 85049$11
Bartonella antibodyCPT 86611$33
Basic metabolic panelCPT 80048$38
Bile acids totalCPT 82239$31
Bilirubin directCPT 82248$31
Bilirubin totalCPT 82247$31
Bilirubin total transcutCPT 88720$13
Bl smear w/diff wbc countCPT 85007$11
Blood culture for bacteriaCPT 87040$36
Blood gases any combinationCPT 82803$74
Blood phCPT 82800$66
Blood test, clotting timeCPT 85610$22
Blood test, comprehensive group of blood chemicalsCPT 80053$80
Blood test, lipidsCPT 80061$45
Blood test, thyroid stimulating hormone (TSH)CPT 84443$69
Blood typing rbc antigensCPT 86905$75
Blood typing serologic aboCPT 86900$16
Blood typing serologic rh(d)CPT 86901$16
Body fluid cell countCPT 89050$18
Body fluid cell countCPT 89051$32
C diff amplified probeCPT 87493$63
C-reactive proteinCPT 86140$35
C-reactive protein hsCPT 86141$38
Capillary blood drawCPT 36416$6
Carcinoembryonic antigenCPT 82378$38
Ccp antibodyCPT 86200$33
Chorionic gonadotropin assayCPT 84703$29
Chorionic gonadotropin testCPT 84702$64
Chylmd trach dna amp probeCPT 87491$63
Cmv antibodyCPT 86644$40
Cmv antibody igmCPT 86645$40
Coagulation assessment blood testCPT 85730$29
Coccidioides antibodyCPT 86635$17
Compatibility test antiglobCPT 86922$29
Compatibility test incubateCPT 86921$43
Compatibility test spinCPT 86920$29
Complete blood cell count (CBC), automatedCPT 85027$34
Complete blood cell count (CBC), with differential white b...CPT 85025$27
Coombs test directCPT 86880$23
Creatine mb fractionCPT 82553$43
Creatinine clearance testCPT 82575$60
Cultr bacteria except bloodCPT 87075$35
Culture aerobic identifyCPT 87077$24
Culture othr specimn aerobicCPT 87070$38
Culture screen onlyCPT 87081$40
DehydroepiandrosteroneCPT 82627$44
Detect agent nos dna ampCPT 87798$63
Drug scrn quan levetiracetamCPT 80177$26
Drug test prsmv chem anlyzrCPT 80307$46
Electrolyte panelCPT 80051$23
Epstein-barr capsid vcaCPT 86665$38
F5 geneCPT 81241$110
Feces culture aerobic bactCPT 87045$40
Fibrin degradation quantCPT 85379$51
Fibrinogen activityCPT 85384$23
Free assay (ft-3)CPT 84481$52
Giardia ag iaCPT 87329$22
Glucose blood testCPT 82962$4
Glucose other fluidCPT 82945$26
Glucose testCPT 82950$31
Glucose tolerance test (gtt)CPT 82951$52
Glycosylated hemoglobin testCPT 83036$40
H pylori (c-13) breathCPT 83013$47
HematocritCPT 85014$14
HemoglobinCPT 85018$14
Hep b core antibody totalCPT 86704$22
Hepatitis b surface ag iaCPT 87340$30
Hepatitis c ab testCPT 86803$38
Hepatitis c revrs trnscrpjCPT 87522$92
Herpes simplex nes antbdyCPT 86694$37
Histoplasma antibodyCPT 86698$18
Histoplasma capsul ag iaCPT 87385$17
Hiv-1/hiv-2 1 result antbdyCPT 86703$26
Hla typing a b or cCPT 86812$47
Hpylori stool ag iaCPT 87338$33
Igg 1 2 3 or 4 eachCPT 82787$36
Immunfix e-phorsis/urine/csfCPT 86335$57
Immunoassay infectious agentCPT 86317$38
Immunoassay nonantibodyCPT 83516$17
Immunoassay tumor ca 125CPT 86304$38
Immunoassay tumor ca 19-9CPT 86301$38
Immunofix e-phoresis serumCPT 86334$41
Influenza assay w/opticCPT 87804$37
Iron binding testCPT 83550$16
Kidney function panel testCPT 80069$40
Lactate (ld) (ldh) enzymeCPT 83615$42
Lactoferrin fecal (qual)CPT 83630$35
Liver function blood testCPT 80076$35
Macroscopic exam parasiteCPT 87169$13
Metabolic panel ionized caCPT 80047$38
Microbe susceptible enzymeCPT 87185$12
Microbe susceptible micCPT 87186$39
Microsomal antibody eachCPT 86376$26
Mumps antibodyCPT 86735$24
Mycobacteria cultureCPT 87116$55
N.gonorrhoeae dna amp probCPT 87591$63
Nuclear antigen antibodyCPT 86235$34
Obstetric blood test panelCPT 80055$91
Occult blood fecesCPT 82270$27
Other source albumin quan eaCPT 82042$20
Particle agglut antbdy scrnCPT 86403$20
Protein e-phoresis serumCPT 84165$35
Rbc antibody identificationCPT 86870$75
Rbc antibody screenCPT 86850$31
Rbc sed rate automatedCPT 85652$24
Rheumatoid factor quantCPT 86431$26
Ria nonantibodyCPT 83519$47
Routine venipunctureCPT 36415$11
Rsv assay w/opticCPT 87807$29
Rubella antibodyCPT 86762$28
Rubeola antibodyCPT 86765$23
Smear fluorescent/acid staiCPT 87206$26
Smear gram stainCPT 87205$25
Smear wet mount saline/inkCPT 87210$13
Specimen infect agnt concntjCPT 87015$16
Strep a ag iaCPT 87430$30
Syphilis test non-trep qualCPT 86592$29
Test for acetone/ketonesCPT 82009$14
Total cortisolCPT 82533$44
Total prostate-specific antigen (PSA) testCPT 84153$38
Total prostate-specific antigen (PSA) testCPT 84154$27
Ur albumin quantitativeCPT 82043$20
Urinalysis testCPT 81003$15
Urinalysis test (Not Offered)CPT 81002--
Urinalysis test using microscopeCPT 81001$20
Urinalysis test using microscopeCPT 81000$27
Urine culture/colony countCPT 87086$38
Urine pregnancy testCPT 81025$33
Varicella-zoster antibodyCPT 86787$19
Vit d 1 25-dihydroxyCPT 82652$77
Vitamin b-12CPT 82607$38
Vitamin d 25 hydroxyCPT 82306$63
West nile virus ab igmCPT 86788$36
West nile virus antibodyCPT 86789$36
Language Pathology
Evaluate swallowing functionCPT 92610$59
Motion fluoroscopy/swallowCPT 92611$97
Speech sound lang comprehenCPT 92523$127
MRI ScanCPT 70553$1,078
MRI scan of leg jointCPT 73721$646
MRI scan of lower spinal canalCPT 72148$666
Medical and Surgical Supplies
Astigmatism-correct functionHCPCS V2787$289
IPG KIT (NIPG1500)HCPCS C1822$18,500
Post chmbr intraocular lensHCPCS V2632$126
Presbyopia-correct functionHCPCS V2788$263
Other Diagnostic
Polysom 6/>yrs cpap 4/> parmCPT 95811$2,463
Polysom <6 yrs 4/> paramtrsCPT 95782$2,463
Other Procedures and Observation
Collect blood from piccCPT 36592$63
Direct refer hospital observHCPCS G0379$133
Hospital observation per hrHCPCS G0378$29
Insj picc 5 yr+ w/o imagingCPT 36569$554
Irrig drug delivery deviceCPT 96523$52
Office o/p est low 20-29 minCPT 99213$59
Office o/p est mod 30-39 minCPT 99214$70
Office o/p est sf 10-19 minCPT 99212$48
Withdrawal of arterial bloodCPT 36600$23
Other Therapeutic
Behav chng smoking 3-10 minCPT 99406$13
Blood transfusion serviceCPT 36430$369
Cardiac rehab/monitorCPT 93798$76
Med nutrition indiv subseqCPT 97803$38
Medical nutrition indiv inCPT 97802$50
Plasma 1 donor frz w/in 8 hrHCPCS P9017$47
Platelet pheres leukoreducedHCPCS P9035$374
Pulmonary rehab w exerHCPCS G0424$53
Rbc leukocytes reducedHCPCS P9016$172
Rbc leukoreduced irradiatedHCPCS P9040$260
Ultraviolet light therapyCPT 96900$34
Family psychotherapy, including patient, 50 min (Not Offered)CPT 90847--
Family psychotherapy, not including patient, 50 min (Not Offered)CPT 90846--
Group psychotherapy (Not Offered)CPT 90853--
Psychotherapy, 30 min (Not Offered)CPT 90832--
Psychotherapy, 45 min (Not Offered)CPT 90834--
Psychotherapy, 60 min (Not Offered)CPT 90837--
Pulmonary Function
Evaluation of wheezingCPT 94060$156
Measure blood oxygen levelCPT 94761$164
Measure blood oxygen levelCPT 94760$41
Measure blood oxygen levelCPT 94762$74
X-Ray of lower backCPT 72110$150
X-ray exam abdomen 1 viewCPT 74018$55
X-ray exam abdomen 2 viewsCPT 74019$81
X-ray exam chest 1 viewCPT 71045$55
X-ray exam chest 2 viewsCPT 71046$73
X-ray exam hip uni 1 viewCPT 73501$40
X-ray exam hip uni 2-3 viewsCPT 73502$69
X-ray exam of femur 2/>CPT 73552$48
X-ray exam of handCPT 73120$59
Airway inhalation treatmentCPT 94640$108
Cbt 1st hourCPT 94644$87
Chest wall manipulationCPT 94668$35
Chest wall manipulationCPT 94667$108
Evaluate pt use of inhalerCPT 94664$44
Pos airway pressure cpapCPT 94660$108
Therapeutic procd strg endurHCPCS G0237$35
Vent mgmt inpat init dayCPT 94002$246
Vent mgmt inpat subq dayCPT 94003$246
Surgical Procedures
Biopsy exam of esophagus, stomach or small bowel using an ...CPT 43239$1,022
Biopsy exam of large bowel using an endoscopeCPT 45380$1,022
Biopsy of prostate gland (Not Offered)CPT 55700--
Diagnostic exam of esophagus, stomach or small bowel using...CPT 43235$1,109
Diagnostic exam of large bowel using an endoscopeCPT 45378$953
Drain/inj joint/bursa w/o usCPT 20610$95
Fna bx w/us gdn 1st lesCPT 10005$337
Injection for shoulder x-rayCPT 23350$162
Injection(s) of anesthetic into lower spine using imaging ...CPT 64483$600
Injection(s) of therapeutic substanceCPT 62323$300
Injection(s) of therapeutic substanceCPT 62322$207
Insertion of catheter into left heart for diagnosis (Not Offered)CPT 93452--
Mod sed same phys/qhp 5/>yrsCPT 99152$50
Mod sed same phys/qhp <5 yrsCPT 99151$50
Mod sed same phys/qhp eaCPT 99153$27
Njx interlaminar crv/thrcCPT 62320$207
Obstetric care, planned cesarean delivery (Not Offered)CPT 59510--
Obstetric care, planned vaginal deliveryCPT 59400$1,297
Obstetric care, planned vaginal delivery (post delivery by... (Not Offered)CPT 59610--
Removal of cataract with insertion of lensCPT 66984$656
Removal of gallbladder using an endoscopeCPT 47562$2,065
Removal of one knee cartilage using an endoscopeCPT 29881$2,096
Removal of one or more breast growth, open procedureCPT 19120$686
Removal of polyps or growths of large bowel using an endos...CPT 45385$443
Removal of recurring cataract in lens capsule using laser (Not Offered)CPT 66821--
Removal of tonsils and adenoid glands, patient younger tha... (Not Offered)CPT 42820--
Repair of groin hernia patient age 5 years or olderCPT 49505$2,156
Shaving of shoulder bone using endoscopeCPT 29826$1,055
Surgical removal of prostate and surrounding lymph nodes u... (Not Offered)CPT 55866--
Ultrasound examination of lower large bowel using an endos... (Not Offered)CPT 45391--
Electric stimulation therapyCPT 97014$20
Gait training therapyCPT 97116$21
Manual therapy 1/> regionsCPT 97140$35
Neuromuscular reeducationCPT 97112$23
Ot eval high complex 60 minCPT 97167$70
Ot eval low complex 30 minCPT 97165$70
Ot eval mod complex 45 minCPT 97166$70
Physical therapy, therapeutic exerciseCPT 97110$47
Pt eval high complex 45 minCPT 97163$62
Pt eval low complex 20 minCPT 97161$51
Pt eval mod complex 30 minCPT 97162$56
Immunization adminCPT 90471$35
Trauma respons w/hosp critiHCPCS G0390$584