Methodist Charlton Medical Center
3500 W Wheatland Road, Dallas, TX · Methodisthealthsystem · · NPI 1275592131
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| In situ hybridization per specimen each additional single probe stain CPT 88364 | $154.50 | $309.00 | $98.28 – $423.32 | 5 |
| In situ hybridization per specimen initial single probe stain CPT 88365 | $401.50 | $803.00 | $132.55 – $570.96 | 61 |
| Instillation anticarcinogenic agent bladder CPT 51720 | $358.00 | $716.00 | $44.85 – $1,849.85 | 60 |
| Insulin total CPT 83525 | $8.00 | $16.00 | $9.12 – $39.28 | 61 |
| Integra matrix wnd inj flowable 3cc-q4114-cost per sq cm HCPCS Q4114 | $1,698.00 | $3,396.00 | $3,917.16 – $3,917.16 | 1 |
| Interrog dev eval icpms ip CPT 93290 | $83.50 | $167.00 | $29.97 – $99.01 | 57 |
| Interrog evl pm/ldls pm ip CPT 93288 | $383.00 | $766.00 | $23.93 – $99.01 | 57 |
| Intra-atrial pacing CPT 93610 | $122.00 | $244.00 | $7,062.85 – $20,691.62 | 57 |
| Intra-atrial recording CPT 93602 | $2,345.00 | $4,690.00 | $7,062.85 – $20,691.62 | 57 |
| Intracard echo interv w/s&i CPT 93662 | $5,801.50 | $11,603.00 | $91.31 – $91.31 | 1 |
| Intracranial complete study CPT 93886 | $1,122.00 | $2,244.00 | $92.59 – $989.12 | 60 |
| Intracranial limited study CPT 93888 | $819.00 | $1,638.00 | $101.02 – $435.14 | 60 |
| Intrapul surf admin endo tube CPT 94610 | $95.50 | $191.00 | $18.79 – $580.92 | 57 |
| Intraventricular pacing CPT 93612 | $4,127.00 | $8,254.00 | $7,062.85 – $20,691.62 | 57 |
| Intrinsic factor antibody CPT 86340 | $12.50 | $25.00 | $12.04 – $51.85 | 61 |
| Intro long gi tube w/mult fluo CPT 74340 | $608.50 | $1,217.00 | $46.90 – $46.90 | 1 |
| Ionm in operatng room 15 min CPT 95940 | $231.00 | $462.00 | $234.53 – $234.53 | 1 |
| Ionm remote/>1 pt or per hr CPT 95941 | $923.00 | $1,846.00 | $96.33 – $96.33 | 1 |
| Iopamidol 250 mg iodine/ml (51 %) intravenous solution HCPCS Q9966 | $164.75 | $329.50 | $13.38 – $13.38 | 1 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $223.75 | $447.50 | $11.47 – $11.47 | 1 |
| Irinotecan 20 mg/ml intravenous solution (wrapper) HCPCS J9206 | $97.25 | $194.50 | $34.18 – $34.18 | 1 |
| Iron CPT 83540 | $176.00 | $352.00 | $5.16 – $22.22 | 61 |
| Iron binding capacity CPT 83550 | $176.00 | $352.00 | $6.97 – $30.04 | 61 |
| Iron dextran 50 mg/ml injection solution HCPCS J1750 | $82.25 | $164.50 | $18.08 – $65.01 | 55 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $146.62 | $293.25 | $167.30 – $167.30 | 1 |
| Irradiation of blood product each unit reference CPT 86945 | $47.50 | $95.00 | $36.70 – $99.09 | 57 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $263.00 | $526.00 | $57.96 – $156.50 | 57 |
| Ivc venogram s&i CPT 75825 | $3,066.00 | $6,132.00 | $108.57 – $8,376.44 | 60 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $171.50 | $343.00 | $39.91 – $191.01 | 57 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $171.50 | $343.00 | $12.61 – $12.61 | 1 |
| IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 | $171.50 | $343.00 | $39.91 – $124.22 | 57 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $434.50 | $869.00 | $10.47 – $564.28 | 57 |
| IV inj ra drug dx study CPT 78808 | $2,071.50 | $4,143.00 | $392.80 – $1,060.55 | 57 |
| Ivp w/wo kub w/wo tomography CPT 74400 | $756.50 | $1,513.00 | $128.56 – $553.77 | 60 |
| Jak2 targeted sequence analysis CPT 81279 | $131.50 | $263.00 | $147.79 – $636.59 | 60 |
| John cunningham antibody CPT 86711 | $184.00 | $368.00 | $13.95 – $60.07 | 61 |
| Ketamine and metabolite screen - quest CPT 80357 | $82.50 | $165.00 | $9.81 – $183.09 | 31 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $70.00 | $140.00 | $6.52 – $28.07 | 61 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | $10.62 | $21.25 | $0.33 – $0.90 | 55 |
| Kidney function study CPT 78725 | $863.00 | $1,726.00 | $107.29 – $1,060.55 | 60 |
| Kidney imaging morphology CPT 78700 | $602.50 | $1,205.00 | $152.67 – $1,060.55 | 60 |
| Kidney imag w/bld flow multi CPT 78709 | $1,047.00 | $2,094.00 | $328.22 – $1,440.44 | 60 |
| Kidney img w/bldflw sgl without rx CPT 78707 | $920.00 | $1,840.00 | $207.60 – $1,440.44 | 60 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $708.00 | $1,416.00 | $99.51 – $428.64 | 60 |
| Kit gene analys d816 variant CPT 81273 | $210.00 | $420.00 | $99.65 – $429.21 | 61 |
| Knee MRI (with and without contrast) CPT 73723 | $3,171.50 | $6,343.00 | $342.79 – $1,499.39 | 59 |
| Knee MRI (with contrast) CPT 73722 | $2,805.50 | $5,611.00 | $307.27 – $2,444.14 | 59 |
| Knee MRI (without contrast) CPT 73721 | $2,439.00 | $4,878.00 | $198.40 – $854.57 | 59 |
| Knee X-ray CPT 73564 | $242.50 | $485.00 | $45.08 – $277.35 | 60 |
| Kras gene variants exon 2 CPT 81275 | $572.50 | $1,145.00 | $154.21 – $664.25 | 61 |
| Kyleena, 19.5 mg HCPCS J7296 | $1,603.37 | $3,206.75 | $2,242.42 – $2,242.42 | 1 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $13.12 | $26.25 | $12.91 – $12.91 | 1 |
| Lactate dehydrogenase (ldh) CPT 83615 | $176.00 | $352.00 | $4.82 – $20.75 | 61 |
| Lactic acid CPT 83605 | $370.50 | $741.00 | $9.23 – $39.77 | 61 |
| Lactoferrin fecal qualitative CPT 83630 | $51.50 | $103.00 | $15.72 – $67.72 | 61 |
| Laryngeal function studies CPT 92520 | $431.00 | $862.00 | $58.04 – $352.96 | 57 |
| Laryngoscopic sensory vid CPT 92614 | $432.00 | $864.00 | $54.15 – $146.21 | 57 |
| Laryngoscopy telescopic CPT 31579 | $411.50 | $823.00 | $384.29 – $1,037.59 | 56 |
| Lead capillary CPT 83655 | $9.00 | $18.00 | $9.66 – $41.62 | 61 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,714.00 | $3,428.00 | $73.97 – $756.12 | 60 |
| Leishmania antibody CPT 86717 | $29.00 | $58.00 | $9.78 – $42.11 | 61 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $54.62 | $109.25 | $12.28 – $12.28 | 1 |
| Leukocyte phagocytosis CPT 86344 | $151.00 | $302.00 | $8.29 – $35.72 | 61 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $7.25 | $14.50 | $13.15 – $13.15 | 1 |
| Levetiracetam therapeutic drug level CPT 80177 | $95.00 | $190.00 | $10.57 – $45.54 | 61 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $28.62 | $57.25 | $1.20 – $1.20 | 1 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $19.25 | $38.50 | $47.80 – $47.80 | 1 |
| Lidocaine therapeutic drug level CPT 80176 | $74.50 | $149.00 | $11.72 – $50.50 | 61 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $52.50 | $105.00 | $103.25 – $103.25 | 1 |
| Lipase CPT 83690 | $158.50 | $317.00 | $5.50 – $23.69 | 61 |
| Lipoprotein blood high res frac & quant CPT 83701 | $22.50 | $45.00 | $27.02 – $116.38 | 61 |
| Lipoprotein blood quant CPT 83704 | $37.50 | $75.00 | $27.28 – $117.52 | 61 |
| Lipoprotein direct measurement hdl CPT 83718 | $221.00 | $442.00 | $6.54 – $28.15 | 61 |
| Lipoprotein direct measurement ldl CPT 83721 | $239.00 | $478.00 | $8.38 – $36.09 | 61 |
| Listeria monocytogenes CPT 86723 | $45.50 | $91.00 | $10.53 – $45.34 | 61 |
| Lithium therapeutic drug level CPT 80178 | $275.00 | $550.00 | $5.27 – $22.71 | 61 |
| Liver Function Test CPT 80076 | $288.00 | $576.00 | $6.52 – $28.07 | 61 |
| Liver imaging CPT 78201 | $1,391.50 | $2,783.00 | $170.15 – $1,440.44 | 60 |
| Liver/spleen imag static only CPT 78215 | $892.50 | $1,785.00 | $175.22 – $1,060.55 | 60 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $1,200.50 | $2,401.00 | $122.21 – $1,060.55 | 60 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $4.12 | $8.25 | $0.88 – $0.88 | 1 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $2,943.00 | $5,886.00 | $166.31 – $716.35 | 59 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $2,602.00 | $5,204.00 | $165.06 – $1,370.84 | 59 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $2,263.00 | $4,526.00 | $99.51 – $428.64 | 59 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $3,191.50 | $6,383.00 | $312.67 – $1,370.84 | 59 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,824.00 | $5,648.00 | $265.05 – $1,370.84 | 59 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,455.00 | $4,910.00 | $187.28 – $836.61 | 59 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $467.00 | $934.00 | $38.10 – $277.35 | 60 |
| L/s ratio fetal lung CPT 83661 | $76.50 | $153.00 | $17.55 – $75.58 | 61 |
| Lumbar diskogram s&i CPT 72295 | $1,718.00 | $3,436.00 | $106.02 – $5,180.36 | 60 |
| Lung function test (mbc/mvv) CPT 94200 | $127.50 | $255.00 | $57.96 – $156.50 | 57 |
| Lung Function Test (Spirometry) CPT 94010 | $189.50 | $379.00 | $167.05 – $572.82 | 57 |
| Lung perfusion imaging CPT 78580 | $825.50 | $1,651.00 | $210.14 – $1,060.55 | 60 |
| Lymphatics/lymph node imaging CPT 78195 | $2,071.50 | $4,143.00 | $313.30 – $1,440.44 | 60 |
| Lymphocyte transformation mitogen CPT 86353 | $272.50 | $545.00 | $39.13 – $168.55 | 61 |
| Lymphocytotoxicity assay CPT 86805 | $624.50 | $1,249.00 | $151.23 – $651.41 | 61 |
| Lymph vessel x-ray arm/leg CPT 75801 | $800.50 | $1,601.00 | $270.42 – $1,664.16 | 60 |
| Lymph vessel x-ray arms/legs CPT 75803 | $946.00 | $1,892.00 | $284.62 – $4,176.05 | 60 |
| Lymph vessel x-ray trunk CPT 75805 | $849.00 | $1,698.00 | $297.72 – $8,376.44 | 60 |
| Lymph vessel x-ray trunk CPT 75807 | $2,516.50 | $5,033.00 | $139.21 – $8,376.44 | 60 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.