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 |
|---|---|---|---|---|
| Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin CPT 87324 | $58.50 | $117.00 | $7.04 – $51.84 | 71 |
| Infectious agent antigen immunoassay ql/sq multi step cryptosporidium CPT 87328 | $13.50 | $27.00 | $7.04 – $59.77 | 71 |
| Infectious agent antigen immunoassay ql/sq multi step giardia CPT 87329 | $74.00 | $148.00 | $7.04 – $51.84 | 71 |
| Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool CPT 87338 | $231.00 | $462.00 | $8.44 – $62.22 | 71 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn CPT 87340 | $202.50 | $405.00 | $6.06 – $44.70 | 71 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization CPT 87341 | $64.00 | $128.00 | $6.06 – $44.70 | 71 |
| Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies CPT 87389 | $79.00 | $158.00 | $14.33 – $104.18 | 71 |
| Infectious agent antigen immunoassay ql/sq multi step legionella urine CPT 87449 | $124.00 | $248.00 | $7.04 – $51.84 | 71 |
| Infectious agent antigen immunoassay ql/sq multi step rotavirus CPT 87425 | $11.00 | $22.00 | $7.04 – $51.84 | 71 |
| Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin CPT 87427 | $45.00 | $90.00 | $7.04 – $51.84 | 71 |
| Infectious agent nucleic acid amplified probe CPT 87798 | $433.50 | $867.00 | $20.60 – $151.77 | 71 |
| Infectious agent nucleic acid amplified probe chlamydia trachomatis CPT 87491 | $133.00 | $266.00 | $20.60 – $151.77 | 71 |
| Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s) CPT 87493 | $292.50 | $585.00 | $21.11 – $161.22 | 71 |
| Infectious agent nucleic acid amplified probe cns pathogen 12-25 targets CPT 87483 | $274.00 | $548.00 | $240.12 – $1,803.00 | 68 |
| Infectious agent nucleic acid amplified probe hsv-1 CPT 87529 | $82.50 | $165.00 | $20.60 – $151.77 | 71 |
| Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus CPT 87641 | $126.00 | $252.00 | $20.60 – $151.77 | 71 |
| Infectious agent nucleic acid amplified probe mycobacteria tuberculosis CPT 87556 | $296.00 | $592.00 | $20.60 – $180.32 | 71 |
| Infectious agent nucleic acid amplified probe neisseria gonorrhoeae CPT 87591 | $133.00 | $266.00 | $20.60 – $151.77 | 71 |
| Infectious agent nucleic acid amplified probe sars-cov-2/covid-19 CPT 87635 | $450.00 | $900.00 | $21.55 – $369.95 | 71 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b CPT 87636 | $197.00 | $394.00 | $59.94 – $1,028.36 | 71 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv CPT 87637 | $227.00 | $454.00 | $59.94 – $1,028.36 | 71 |
| Infectious agent nucleic acid amplified probe streptococcus group a CPT 87651 | $80.50 | $161.00 | $20.60 – $151.77 | 71 |
| Infectious agent nucleic acid amplified probe trichomonas vaginalis CPT 87661 | $86.50 | $173.00 | $20.11 – $151.77 | 71 |
| Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae CPT 87494 | $16.50 | $33.00 | $70.18 – $189.49 | 56 |
| Infectious agent nucleic acid amp probe mycobacterium tuberculosis rifampin resistance CPT 87564 | $138.00 | $276.00 | $61.27 – $332.09 | 62 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets CPT 87507 | $654.00 | $1,308.00 | $238.22 – $1,803.00 | 71 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets CPT 87506 | $397.50 | $795.00 | $121.99 – $1,137.67 | 71 |
| Infectious agent nucleic acid quantification bk virus CPT 87799 | $171.50 | $343.00 | $25.14 – $185.30 | 71 |
| Infectious agent nucleic acid quantification hepatitis b CPT 87517 | $102.00 | $204.00 | $25.14 – $185.30 | 71 |
| Infectious agent nucleic acid quantification hepatitis c CPT 87522 | $79.00 | $158.00 | $25.14 – $185.30 | 71 |
| Infectious agent nucleic acid quantification hiv-1 CPT 87536 | $60.00 | $120.00 | $49.93 – $368.14 | 71 |
| Infliximab-dyyb 100 mg intravenous solution HCPCS Q5103 | $1,192.37 | $2,384.75 | $11.55 – $2,142.16 | 62 |
| Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis CPT 94642 | $157.00 | $314.00 | $71.96 – $594.91 | 60 |
| Initiation & management bipap/cpap initial day CPT 94660 | $1,581.50 | $3,163.00 | $91.31 – $594.91 | 60 |
| Inj, aponvie, 1 mg HCPCS C9145 | $116.25 | $232.50 | $1.86 – $143.02 | 58 |
| Inj, bupivacaine liposome HCPCS J0666 | $775.00 | $1,550.00 | $1.44 – $1,020.24 | 62 |
| Inj cefazolin sodium, hikma HCPCS J0688 | $562.25 | $1,124.50 | $1.00 – $554.48 | 10 |
| Injection during cath supravalvular aortography CPT 93567 | $151.00 | $302.00 | $3,884.57 – $3,884.57 | 1 |
| Injection,onabotulinumtoxina HCPCS J0585 | $820.37 | $1,640.75 | $6.47 – $1,395.76 | 62 |
| Injection(s) tendon sheath/ligament aponeurosis single (both sides) CPT 20550 | $445.50 | $891.00 | $23.54 – $6,261.00 | 66 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug CPT 96375 | $230.50 | $461.00 | $26.40 – $127.21 | 60 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 | $230.50 | $461.00 | $39.91 – $39.91 | 1 |
| Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug CPT 96374 | $230.50 | $461.00 | $26.40 – $577.87 | 60 |
| Injection therapeutic/prophylactic/diagnostic subcutaneous/im CPT 96372 | $168.50 | $337.00 | $25.15 – $195.61 | 60 |
| Inject sacroiliac joint CPT 27096 | $1,107.50 | $2,215.00 | $661.61 – $1,136.43 | 30 |
| Inj hrt cath w/s&i nonsel p-art angrp CPT 93568 | $185.00 | $370.00 | $3,884.57 – $3,884.57 | 1 |
| Inj levocarnitine per 1 gm HCPCS J1955 | $81.75 | $163.50 | $35.96 – $79.16 | 6 |
| Inj mepivacaine hcl/10 ml HCPCS J0670 | $29.62 | $59.25 | $6.31 – $13.27 | 6 |
| Inj retacrit esrd on dialysi HCPCS Q5105 | $210.25 | $420.50 | $0.75 – $255.73 | 10 |
| Inj sulf hexa lipid microsph HCPCS Q9950 | $269.75 | $539.50 | $140.38 – $346.55 | 6 |
| Insertion catheter bladder temporary simple CPT 51702 | $190.50 | $381.00 | $123.15 – $6,261.00 | 63 |
| Insert swan-ganz cath CPT 93503 | $1,855.50 | $3,711.00 | $1,484.09 – $17,864.00 | 63 |
| Insitu hybridization auto CPT 88367 | $155.50 | $311.00 | $14.62 – $973.82 | 75 |
| Insitu hybridization (fish) CPT 88366 | $366.00 | $732.00 | $36.34 – $1,009.26 | 75 |
| Insitu hybridization manual CPT 88368 | $325.50 | $651.00 | $14.62 – $973.82 | 75 |
| In situ hybridization per specimen each additional single probe stain CPT 88364 | $154.50 | $309.00 | $29.43 – $469.30 | 19 |
| In situ hybridization per specimen initial single probe stain CPT 88365 | $401.50 | $803.00 | $14.62 – $616.02 | 75 |
| Instillation anticarcinogenic agent bladder CPT 51720 | $358.00 | $716.00 | $44.85 – $6,261.00 | 66 |
| Insulin total CPT 83525 | $8.00 | $16.00 | $6.71 – $49.46 | 71 |
| 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 – $101.39 | 63 |
| Interrog evl pm/ldls pm ip CPT 93288 | $383.00 | $766.00 | $23.93 – $109.28 | 63 |
| Intra-atrial pacing CPT 93610 | $122.00 | $244.00 | $7,249.37 – $21,189.91 | 60 |
| Intra-atrial recording CPT 93602 | $2,345.00 | $4,690.00 | $7,249.37 – $21,189.91 | 60 |
| 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 – $1,032.99 | 66 |
| Intracranial limited study CPT 93888 | $819.00 | $1,638.00 | $101.02 – $454.44 | 66 |
| Intrapul surf admin endo tube CPT 94610 | $95.50 | $191.00 | $18.79 – $594.91 | 60 |
| Intraventricular pacing CPT 93612 | $4,127.00 | $8,254.00 | $7,249.37 – $21,189.91 | 60 |
| Intrinsic factor antibody CPT 86340 | $12.50 | $25.00 | $8.85 – $65.25 | 71 |
| Intro long gi tube w/mult fluo CPT 74340 | $608.50 | $1,217.00 | $46.90 – $357.76 | 6 |
| 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 | $120.25 | $240.50 | $6.69 – $6.69 | 1 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $223.75 | $447.50 | $3.82 – $3.82 | 1 |
| Iron CPT 83540 | $176.00 | $352.00 | $3.80 – $27.97 | 71 |
| Iron binding capacity CPT 83550 | $176.00 | $352.00 | $5.13 – $37.78 | 71 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $120.87 | $241.75 | $36.72 – $83.65 | 6 |
| Irradiation of blood product each unit reference CPT 86945 | $47.50 | $95.00 | $8.58 – $130.57 | 72 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $263.00 | $526.00 | $56.75 – $160.27 | 63 |
| Ivc venogram s&i CPT 75825 | $3,066.00 | $6,132.00 | $108.57 – $8,578.16 | 66 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $171.50 | $343.00 | $39.91 – $195.61 | 60 |
| 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 – $127.21 | 60 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $434.50 | $869.00 | $10.47 – $577.87 | 60 |
| IV inj ra drug dx study CPT 78808 | $2,071.50 | $4,143.00 | $142.11 – $1,086.09 | 63 |
| Ivp w/wo kub w/wo tomography CPT 74400 | $756.50 | $1,513.00 | $128.56 – $578.33 | 66 |
| Jak2 targeted sequence analysis CPT 81279 | $131.50 | $263.00 | $77.78 – $801.18 | 71 |
| John cunningham antibody CPT 86711 | $184.00 | $368.00 | $8.31 – $73.04 | 71 |
| Ketamine and metabolite screen - quest CPT 80357 | $82.50 | $165.00 | $0.06 – $183.09 | 44 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $70.00 | $140.00 | $4.80 – $35.33 | 71 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | $10.62 | $21.25 | $0.33 – $1.19 | 62 |
| Kidney function study CPT 78725 | $863.00 | $1,726.00 | $107.29 – $1,086.09 | 66 |
| Kidney imaging morphology CPT 78700 | $602.50 | $1,205.00 | $152.67 – $1,086.09 | 66 |
| Kidney imag w/bld flow multi CPT 78709 | $1,047.00 | $2,094.00 | $328.22 – $1,476.45 | 66 |
| Kidney img w/bldflw sgl without rx CPT 78707 | $920.00 | $1,840.00 | $207.60 – $1,475.12 | 66 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $708.00 | $1,416.00 | $99.51 – $447.65 | 66 |
| Kit gene analys d816 variant CPT 81273 | $210.00 | $420.00 | $52.45 – $540.17 | 71 |
| Knee MRI (with and without contrast) CPT 73723 | $3,171.50 | $6,343.00 | $341.19 – $1,565.90 | 62 |
| Knee MRI (with contrast) CPT 73722 | $2,805.50 | $5,611.00 | $307.27 – $2,444.14 | 62 |
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.