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 |
|---|---|---|---|---|
| Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr HCPCS J1335 | $217.75 | $435.50 | $161.18 – $161.18 | 1 |
| ER Visit (level 1, minor) CPT 99281 | $262.00 | $524.00 | $82.85 – $223.70 | 56 |
| ER Visit (level 2) CPT 99282 | $463.00 | $926.00 | $150.87 – $407.34 | 56 |
| ER Visit (level 3) CPT 99283 | $978.00 | $1,956.00 | $268.21 – $724.18 | 56 |
| ER Visit (level 4) CPT 99284 | $1,291.00 | $2,582.00 | $409.98 – $1,106.95 | 56 |
| ER Visit (level 5, high severity) CPT 99285 | $1,774.50 | $3,549.00 | $585.14 – $1,579.88 | 56 |
| Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1364 | $367.50 | $735.00 | $177.82 – $177.82 | 1 |
| Esophageal dilat s&i CPT 74360 | $1,015.00 | $2,030.00 | $48.72 – $48.72 | 1 |
| Esophagus motility study CPT 91010 | $1,043.00 | $2,086.00 | $93.71 – $989.94 | 57 |
| Esoph balloon distension tst CPT 91040 | $773.50 | $1,547.00 | $94.19 – $989.94 | 57 |
| Esoph imped funct test > 1hr CPT 91038 | $674.00 | $1,348.00 | $366.65 – $989.94 | 57 |
| Established Patient Office Visit (level 1) CPT 99211 | $184.50 | $369.00 | $8.22 – $209.30 | 57 |
| Established Patient Office Visit (level 2) CPT 99212 | $195.00 | $390.00 | $33.14 – $209.30 | 57 |
| Established Patient Office Visit (level 3) CPT 99213 | $211.00 | $422.00 | $61.39 – $209.30 | 57 |
| Established Patient Office Visit (level 4) CPT 99214 | $321.00 | $642.00 | $26.40 – $227.75 | 57 |
| Established Patient Office Visit (level 5) CPT 99215 | $367.50 | $735.00 | $48.76 – $338.39 | 57 |
| Estradiol total CPT 82670 | $25.00 | $50.00 | $22.30 – $96.04 | 61 |
| Ethylene glycol -sendout CPT 82693 | $24.50 | $49.00 | $11.89 – $51.23 | 61 |
| Etoposide 20 mg/ml intravenous solution HCPCS J9181 | $70.75 | $141.50 | $15.54 – $15.54 | 1 |
| Eval/fit voice prosthesis iii, st CPT 92607 | $433.00 | $866.00 | $46.15 – $332.45 | 57 |
| Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen CPT 84112 | $325.00 | $650.00 | $78.29 – $337.22 | 61 |
| Evaluation heart device CPT 93640 | $887.50 | $1,775.00 | $13,487.28 – $13,487.28 | 1 |
| Evaluation of speech fluency 92521 CPT 92521 | $433.00 | $866.00 | $7.13 – $362.69 | 57 |
| Evaluation psychiatric diagnostic CPT 90791 | $197.00 | $394.00 | not published | 0 |
| Event monitor CPT 93270 | $43.00 | $86.00 | $6.10 – $99.01 | 61 |
| Evoked oa emissions ltd CPT 92587 | $193.00 | $386.00 | $82.54 – $572.82 | 57 |
| Evoked potentials upper limbs CPT 95925 | $1,439.50 | $2,879.00 | $33.30 – $572.82 | 57 |
| Evoked potential visual not glaucoma CPT 95930 | $942.50 | $1,885.00 | $22.12 – $572.82 | 57 |
| Ewho w/joint(s) cf HCPCS L3764 | $107.50 | $215.00 | $855.35 – $2,309.45 | 54 |
| Exam of vagina w/scope 57420 CPT 57420 | $144.00 | $288.00 | $299.41 – $808.41 | 56 |
| Exome sequence analysis CPT 81415 | $2,456.50 | $4,913.00 | $4,780.00 – $12,906.00 | 57 |
| Exome sequence analysis CPT 81416 | $6,600.00 | $13,200.00 | $12,000.00 – $32,400.00 | 57 |
| Ext ecg>48hr<7d scan a/r CPT 93243 | $131.00 | $262.00 | $87.94 – $352.96 | 57 |
| External chromosome analysis 20-25 cells CPT 88264 | $288.50 | $577.00 | $115.40 – $497.06 | 61 |
| External tissue culture neoplastic disorders bone marrow/blood cells CPT 88237 | $169.00 | $338.00 | $114.71 – $494.11 | 61 |
| Extractable nuclear antigen/antibody any method each antibody centromere CPT 86235 | $60.50 | $121.00 | $14.31 – $61.63 | 61 |
| Facial bones <3 CPT 70140 | $353.00 | $706.00 | $30.48 – $230.87 | 60 |
| Factor ix CPT 85250 | $30.00 | $60.00 | $15.19 – $65.43 | 61 |
| Factor viii CPT 85240 | $34.00 | $68.00 | $14.29 – $61.54 | 61 |
| Fancc gene CPT 81242 | $33.50 | $67.00 | $29.22 – $125.87 | 61 |
| Fat/lipids feces qualitative CPT 82705 | $9.00 | $18.00 | $4.07 – $17.51 | 61 |
| Fatty acids nonesterified CPT 82725 | $39.50 | $79.00 | $14.98 – $64.53 | 61 |
| Fecal microbiota prep instil HCPCS G0455 | $2,182.00 | $4,364.00 | $913.73 – $2,467.07 | 57 |
| #fecal-sodium CPT 84302 | $9.50 | $19.00 | $3.88 – $16.70 | 61 |
| Fees w/laryngeal sense test CPT 92616 | $432.00 | $864.00 | $79.98 – $215.95 | 57 |
| Felbamate (felbatol(r)) - sendout CPT 80167 | $14.50 | $29.00 | $14.88 – $64.08 | 61 |
| Feno poc CPT 95012 | $105.50 | $211.00 | $22.06 – $99.09 | 57 |
| Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) HCPCS J3010 | $13.00 | $26.00 | $0.93 – $0.93 | 1 |
| Ferritin CPT 82728 | $182.00 | $364.00 | $10.88 – $46.85 | 61 |
| Fetal aneuploidy trisom risk CPT 81507 | $698.50 | $1,397.00 | $634.41 – $2,732.64 | 61 |
| Fetal biophys profile w/nst 76818 CPT 76818 | $754.00 | $1,508.00 | $99.51 – $428.64 | 60 |
| Fetal chrmoml microdeltj CPT 81422 | $698.50 | $1,397.00 | $759.05 – $2,049.44 | 57 |
| Fetal fibronectin CPT 82731 | $1,187.00 | $2,374.00 | $51.40 – $221.38 | 61 |
| Fetal hemoglobin (kleihauer betke) CPT 85460 | $124.00 | $248.00 | $6.17 – $26.56 | 61 |
| Fetal lung maturity assess lam body dnst CPT 83664 | $13.50 | $27.00 | $15.42 – $66.41 | 61 |
| Fetal non stress test CPT 59025 | $750.00 | $1,500.00 | $29.61 – $536.34 | 57 |
| #_fet/norfentcnfrmur CPT 80354 | $57.50 | $115.00 | $12.17 – $183.09 | 31 |
| Fibrin degradation d dimer quantitative CPT 85379 | $235.00 | $470.00 | $8.12 – $34.99 | 61 |
| Fibrin degradation products CPT 85362 | $147.00 | $294.00 | $5.50 – $23.69 | 61 |
| Fibrinogen activity CPT 85384 | $147.00 | $294.00 | $7.75 – $33.39 | 61 |
| Fibrinolysins/coagulopathy screen interpretation/report CPT 85390 | $83.50 | $167.00 | $12.35 – $53.20 | 61 |
| Fibrinolytic antiplasmin CPT 85410 | $30.00 | $60.00 | $6.16 – $26.52 | 61 |
| Fibrinolytic plasminogen CPT 85415 | $40.50 | $81.00 | $13.72 – $59.09 | 61 |
| Fibrinolytic plasminogen xcpt antgnc asa CPT 85420 | $16.00 | $32.00 | $5.22 – $22.47 | 61 |
| Flecainide (tambocor)-sendout CPT 80181 | $14.50 | $29.00 | $14.88 – $64.08 | 61 |
| Flow cytometry interp 16 or more CPT 88189 | $90.00 | $180.00 | $79.24 – $213.95 | 57 |
| Flow cytometry marker each additional CPT 88185 | $122.00 | $244.00 | $39.29 – $39.29 | 1 |
| Flow cytometry one marker technical component CPT 88184 | $331.00 | $662.00 | $352.19 – $950.92 | 57 |
| #flow interp 9 - 15 markers CPT 88188 | $56.50 | $113.00 | $58.45 – $157.82 | 57 |
| Flt3 gene CPT 81245 | $172.50 | $345.00 | $132.08 – $568.91 | 61 |
| Flt3 gene analysis CPT 81246 | $172.50 | $345.00 | $66.23 – $285.29 | 61 |
| Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback HCPCS J1450 | $29.50 | $59.00 | $30.16 – $30.16 | 1 |
| Fluidotherapy charges pt CPT 97022 | $112.00 | $224.00 | $14.03 – $42.50 | 57 |
| Fluorescent antibody titer dna CPT 86256 | $461.50 | $923.00 | $9.61 – $41.41 | 61 |
| Fluoroguide for spine inject 77003-26 CPT 77003 | $333.50 | $667.00 | $116.32 – $116.32 | 1 |
| Fluoroguide needle placement CPT 77002 | $310.00 | $620.00 | $126.07 – $126.07 | 1 |
| Fluoroscopy up to 1 hour CPT 76000 | $216.50 | $433.00 | $40.64 – $632.98 | 60 |
| Fluorouracil 50 mg/ml intravenous solution (wrapper) HCPCS J9190 | $57.37 | $114.75 | $5.16 – $5.16 | 1 |
| Fluphenazine decanoate 25 mg/ml injection solution HCPCS J2680 | $288.25 | $576.50 | $235.18 – $235.18 | 1 |
| Folic acid CPT 82746 | $208.00 | $416.00 | $11.73 – $50.54 | 61 |
| Follow-up angiography CPT 75898 | $1,265.00 | $2,530.00 | $127.02 – $8,376.44 | 60 |
| Fomepizole 1 gram/ml intravenous solution HCPCS J1451 | $1,293.87 | $2,587.75 | $6.43 – $2,478.43 | 55 |
| Fondaparinux sodium HCPCS J1652 | $199.37 | $398.75 | $27.84 – $27.84 | 1 |
| Foot X-ray CPT 73630 | $324.00 | $648.00 | $32.69 – $230.87 | 60 |
| Fosaprepitant 150 mg intravenous powder for solution HCPCS J1453 | $152.87 | $305.75 | $516.24 – $516.24 | 1 |
| Fosphenytoin 50 mg pe/ml injection (wrapper) HCPCS Q2009 | $9.00 | $18.00 | $1.34 – $15.68 | 55 |
| _fragile x methylation-sendout CPT 81244 | $356.50 | $713.00 | $35.82 – $154.31 | 61 |
| Fresh frozen plasma 8-24 hours collection each unit HCPCS P9059 | $52.00 | $104.00 | $73.77 – $199.18 | 56 |
| Fresh frozen plasma frozen within 8 hours of collection each unit HCPCS P9017 | $192.50 | $385.00 | $85.98 – $232.15 | 56 |
| Fresh frozen plasma thawing ea un CPT 86927 | $165.50 | $331.00 | $20.49 – $451.97 | 57 |
| Frozen blood thaw CPT 86931 | $116.50 | $233.00 | $167.40 – $451.97 | 57 |
| Frozen plasma, pooled, sd HCPCS P9023 | $159.00 | $318.00 | $55.96 – $151.09 | 57 |
| Fructosamine glycated protein CPT 82985 | $13.00 | $26.00 | $13.38 – $57.62 | 61 |
| Ftl cgen abnor four anal CPT 81511 | $94.00 | $188.00 | $153.50 – $414.45 | 56 |
| Ftl cgen abnor two proteins CPT 81508 | $64.00 | $128.00 | $54.30 – $146.61 | 56 |
| Furosemide 10 mg/ml injection solution HCPCS J1938 | $238.00 | $476.00 | $4.78 – $4.78 | 1 |
| G6pc gene CPT 81250 | $35.50 | $71.00 | $46.67 – $201.04 | 61 |
| G6pd full gene sequence CPT 81249 | $675.00 | $1,350.00 | $478.80 – $2,062.37 | 61 |
| Gabapentin non-blood CPT 80355 | $105.50 | $211.00 | $7.32 – $250.54 | 31 |
| Gadobutrol 1 mmol/ml intravenous solution (wrapper) HCPCS A9585 | $115.87 | $231.75 | $69.91 – $69.91 | 1 |
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.