Texas Health Arlington Memorial Hospital — price list

← Hospital overviewVerified from Texas Health Arlington Memorial Hospital’s published price file

Includes cash prices, list prices, insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Showing the first 1,500 prices from a large file. Search a procedure or code below to narrow the list.

How to read these columns

List: The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
Cash: The discounted self-pay price for paying directly, without insurance.
Negotiated: Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.

These are the hospital’s published reference prices, not a personalized estimate of your bill.

13 prices shown (filtered).

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLN [20400] Inpatient	J9017 HCPCS	$1,960	$1,176	$678 – $1,845	—
EPINEPHRINE 0.1 MG/ML INJECTION SYRG [13857] Inpatient	J0171 HCPCS	$23.90	$14.34	$8.26 – $22.49	—
EPINEPHRINE 0.1 MG/ML NEONATAL ENDOTRACHEAL SYRINGE [300923] Inpatient	J0171 HCPCS	$23.90	$14.34	$8.26 – $22.49	—
EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLN [111269] Inpatient	J0171 HCPCS	$10.00	$6.00	$3.46 – $9.41	—
EPINEPHRINE 1 MG/ML INJECTION KIT [130819] Inpatient	J0171 HCPCS	$195	$117	$67.43 – $184	—
EPINEPHRINE 1 MG/ML INJECTION SOLN [29663] Inpatient	J0171 HCPCS	$902	$541	$312 – $849	—
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLN [89418] Inpatient	J0171 HCPCS	$66.50	$39.90	$23.00 – $62.58	—
EPINEPHRINE HCL IN 5% DEXTROSE 4 MG/250 ML (16 MCG/ML) INTRAVENOUS SOLN [117437] Inpatient	J0171 HCPCS	$75.05	$45.03	$25.95 – $70.62	—
HYDROXYZINE PAMOATE 25 MG ORAL CAP [20700] Inpatient	Q0177 HCPCS	$1.00	$0.60	$0.35 – $0.94	—
LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLN [101759] Inpatient	C9254 HCPCS	$87.00	$52.20	$30.08 – $81.87	—
PERPHENAZINE 2 MG ORAL TAB [1892] Inpatient	Q0175 HCPCS	$3.06	$1.84	$1.06 – $2.88	—
PERPHENAZINE 4 MG ORAL TAB [14122] Inpatient	Q0175 HCPCS	$1.39	$0.84	$0.48 – $1.31	—
PERPHENAZINE 8 MG ORAL TAB [18275] Inpatient	Q0175 HCPCS	$1.00	$0.60	$0.35 – $0.94	—