Methodist Southlake Medical Center
421 E State Hwy 114, Souhtlake, TX · Methodisthealthsystem · · NPI 1568818417
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 |
|---|---|---|---|---|
| 11-desoxycortisol - sendout CPT 82634 | $65.50 | $131.00 | $17.18 – $126.68 | 71 |
| 17-hydroxypregnenolone CPT 84143 | $51.50 | $103.00 | $13.39 – $98.70 | 71 |
| 17-ketosteroids CPT 83586 | $16.00 | $32.00 | $7.51 – $55.37 | 71 |
| 24 hr ambulatory b/p monitor CPT 93786 | $131.00 | $262.00 | $123.15 – $361.46 | 59 |
| 3d ech img cgen car anomal CPT 93319 | $490.50 | $981.00 | $23.00 – $103.46 | 9 |
| 3-d radiotherapy plan CPT 77295 | $3,679.50 | $7,359.00 | $671.17 – $3,760.37 | 63 |
| 3d recon without postprocess indpndt CPT 76376 | $1,908.50 | $3,817.00 | $22.53 – $22.53 | 1 |
| 5' nucleotidase - sendout CPT 83915 | $14.50 | $29.00 | $6.54 – $48.23 | 71 |
| 88334 ap bill cytologic exam each additional site CPT 88334 | $124.00 | $248.00 | $6.23 – $86.02 | 16 |
| #a/b/c/c/h pnl-candida albicans ab CPT 86628 | $57.00 | $114.00 | $7.05 – $51.98 | 71 |
| Abd aorta w/runoff s&i CPT 75630 | $3,583.00 | $7,166.00 | $149.19 – $8,578.16 | 66 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $2,569.00 | $5,138.00 | $166.31 – $748.12 | 62 |
| Abdominal CT scan (with contrast) CPT 74160 | $2,273.00 | $4,546.00 | $166.31 – $748.12 | 62 |
| Abdominal CT scan (without contrast) CPT 74150 | $1,977.00 | $3,954.00 | $99.51 – $447.65 | 62 |
| Abdominal MRI (with and without contrast) CPT 74183 | $2,967.00 | $5,934.00 | $331.08 – $1,489.31 | 62 |
| Abdominal MRI (with contrast) CPT 74182 | $2,625.00 | $5,250.00 | $296.16 – $1,370.84 | 62 |
| Abdominal MRI (without contrast) CPT 74181 | $2,282.50 | $4,565.00 | $191.72 – $862.44 | 62 |
| Abdominal Ultrasound (complete) CPT 76700 | $783.00 | $1,566.00 | $99.51 – $447.65 | 66 |
| Abdominal Ultrasound (limited) CPT 76705 | $506.50 | $1,013.00 | $82.85 – $372.69 | 66 |
| Abl1 gene CPT 81170 | $589.00 | $1,178.00 | $138.39 – $1,297.80 | 71 |
| Ablate arrhythmia add on CPT 93655 | $1,384.50 | $2,769.00 | $11.89 – $6,261.00 | 6 |
| Ablate heart dysrhythm focus CPT 93650 | $4,596.50 | $9,193.00 | $7,249.37 – $21,189.91 | 63 |
| Ablation cardiac vagal inputs atrium CPT 93799 | $9,795.50 | $19,591.00 | $73.97 – $349.58 | 60 |
| Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 | $77.75 | $155.50 | $9.18 – $71.70 | 6 |
| Acetaminophen level CPT 80143 | $238.50 | $477.00 | $7.83 – $80.61 | 71 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $83.37 | $166.75 | $39.55 – $60.16 | 6 |
| Acetone qualitative CPT 82009 | $72.00 | $144.00 | $2.65 – $19.54 | 71 |
| Acetylcholine receptor modulating antibody CPT 86043 | $206.00 | $412.00 | $5.06 – $52.13 | 71 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $204.62 | $409.25 | $33.97 – $311.18 | 6 |
| Aco cont gluc mnt phys/qhp eqp 95250aco CPT 95250 | $503.50 | $1,007.00 | $123.12 – $361.70 | 60 |
| Aco med nutria tx/group, ea 30 min 97804aco CPT 97804 | $87.50 | $175.00 | $12.37 – $33.40 | 56 |
| Acup 1/> without estim ea add 15 CPT 97811 | $43.00 | $86.00 | $84.54 – $84.54 | 1 |
| Acup 1/> wo estim 1st 15 min CPT 97810 | $53.50 | $107.00 | $29.10 – $78.58 | 56 |
| Acute hepatitis panel CPT 80074 | $33.00 | $66.00 | $27.95 – $206.06 | 71 |
| Acyclovir 400 mg tablet HCPCS J8499 | $62.12 | $124.25 | not published | 0 |
| #acylcarnitineprfl CPT 82017 | $105.00 | $210.00 | $9.90 – $72.97 | 71 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $11.62 | $23.25 | $4.87 – $18.07 | 6 |
| Adh-sendout CPT 84588 | $34.00 | $68.00 | $19.92 – $146.80 | 71 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $211.00 | $422.00 | $53.28 – $195.61 | 63 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $211.00 | $422.00 | $67.99 – $195.61 | 63 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $611.00 | $1,222.00 | $115.36 – $897.37 | 63 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $219.50 | $439.00 | $45.67 – $897.37 | 63 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $219.50 | $439.00 | $67.99 – $195.61 | 63 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $219.50 | $439.00 | $39.24 – $207.70 | 63 |
| Administration immunization 1 vaccine CPT 90471 | $55.00 | $110.00 | $26.40 – $195.61 | 60 |
| Administration immunization each additional vaccine CPT 90472 | $55.00 | $110.00 | $7.15 – $7.15 | 1 |
| Aep neurodiagnostic i&r CPT 92653 | $300.50 | $601.00 | $146.34 – $586.61 | 60 |
| _afb id by dna probe rflx ast CPT 87149 | $104.50 | $209.00 | $11.77 – $86.74 | 71 |
| #afb mycobacteria suscep. #1 CPT 87190 | $17.50 | $35.00 | $3.32 – $31.65 | 71 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $111.50 | $223.00 | $69.39 – $499.08 | 71 |
| Albumin body fluid quantitative each specimen CPT 82042 | $75.00 | $150.00 | $3.04 – $33.67 | 71 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $106.87 | $213.75 | $53.08 – $148.68 | 54 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | $174.37 | $348.75 | $53.08 – $297.36 | 58 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $128.00 | $256.00 | $3.40 – $25.02 | 71 |
| Albumin serum plasma or whole blood CPT 82040 | $75.00 | $150.00 | $2.91 – $21.41 | 71 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $29.50 | $59.00 | $7.25 – $74.70 | 71 |
| Alkaline phosphatase CPT 84075 | $134.50 | $269.00 | $3.04 – $22.42 | 71 |
| Allergen alpha lactalbumin ige CPT 86008 | $17.00 | $34.00 | $9.30 – $77.58 | 71 |
| Allergen egg white ige CPT 86003 | $88.50 | $177.00 | $3.07 – $22.57 | 71 |
| Allergen specific ige qual multi scrn ea CPT 86005 | $21.00 | $42.00 | $4.68 – $34.46 | 71 |
| Allograft amnioexcel plus 17mm disk HCPCS Q4137 | $150.00 | $300.00 | $125.22 – $338.09 | 53 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $189.69 | $379.38 | $125.22 – $338.09 | 53 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $74.53 | $149.06 | $125.22 – $338.09 | 53 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $178.13 | $356.27 | $125.22 – $338.09 | 54 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $122.34 | $244.69 | $125.22 – $338.09 | 54 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | $66.75 | $133.50 | $125.22 – $338.09 | 54 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | $112.50 | $225.00 | $37.80 – $278.67 | 71 |
| Alpha-fetoprotein amniotic CPT 82106 | $10.00 | $20.00 | $9.84 – $73.54 | 71 |
| Alpha-fetoprotein tumor marker CPT 82105 | $199.00 | $398.00 | $9.84 – $72.53 | 71 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $11,088.50 | $22,177.00 | $91.48 – $331.70 | 62 |
| Alt/sgpt CPT 84460 | $169.50 | $339.00 | $3.11 – $22.93 | 71 |
| Aluminum - quest CPT 82108 | $18.50 | $37.00 | $14.95 – $110.24 | 71 |
| Amantadine (symmetrel)-sendout CPT 80375 | $227.50 | $455.00 | $0.06 – $183.09 | 44 |
| Ambl bp mntr w/sw a/r CPT 93788 | $131.00 | $262.00 | $123.15 – $361.46 | 59 |
| Amino acid screen, urine CPT 82128 | $120.00 | $240.00 | $8.14 – $59.99 | 71 |
| Aminolevulinic acid delta CPT 82135 | $26.50 | $53.00 | $9.66 – $71.16 | 71 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | $46.25 | $92.50 | $1.63 – $18.39 | 6 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | $87.50 | $175.00 | $46.82 – $109.84 | 6 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $3.75 | $7.50 | $2.39 – $3.59 | 6 |
| Amitriptyline (elavil) -sendout CPT 80335 | $21.00 | $42.00 | $0.06 – $183.09 | 44 |
| Ammonia CPT 82140 | $188.00 | $376.00 | $8.55 – $63.02 | 71 |
| Amniotic fluid scan CPT 82143 | $17.50 | $35.00 | $4.04 – $40.45 | 71 |
| Amphetamine confirm urine -sendout CPT 80324 | $66.50 | $133.00 | $0.06 – $183.09 | 44 |
| Amphetamines 5 or more CPT 80326 | $130.00 | $260.00 | $0.06 – $183.09 | 44 |
| Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 | $473.87 | $947.75 | $20.72 – $590.69 | 62 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $29.37 | $58.75 | $1.84 – $11.47 | 6 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $27.00 | $54.00 | $2.05 – $7.50 | 6 |
| Amylase CPT 82150 | $134.00 | $268.00 | $3.81 – $28.05 | 71 |
| Ana ds-dna CPT 86226 | $7.50 | $15.00 | $7.11 – $52.42 | 71 |
| Analgesics non-opioid definitive assay 1 or 2 acetaminophen CPT 80329 | $276.00 | $552.00 | $0.06 – $183.09 | 44 |
| Anal/urinary muscle study CPT 51785 | $458.00 | $916.00 | $110.15 – $6,261.00 | 66 |
| Analysis gene f2 20210g>a variant CPT 81240 | $67.50 | $135.00 | $28.19 – $284.15 | 71 |
| Analysis gene f5 leiden variant CPT 81241 | $67.50 | $135.00 | $35.02 – $317.38 | 71 |
| Analysis tumor CPT 88358 | $312.00 | $624.00 | $14.62 – $462.86 | 75 |
| Anaplsma phgcytophlm amp prb CPT 87468 | $33.50 | $67.00 | $14.74 – $151.77 | 71 |
| Anca screen with reflex to titer -quest CPT 86021 | $52.00 | $104.00 | $8.83 – $65.11 | 71 |
| An fluoro guide for cvp CPT 77001 | $392.50 | $785.00 | $123.03 – $402.39 | 6 |
| Angiotensin ii 0.5 mg/ml soln 1 ml vial HCPCS J3490 | $3,689.00 | $7,378.00 | not published | 0 |
| Ankle X-ray CPT 73610 | $377.50 | $755.00 | $34.91 – $236.43 | 66 |
| Antibody bacterium, not elsewhere specified CPT 86609 | $75.00 | $150.00 | $7.56 – $55.73 | 71 |
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.