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 |
|---|---|---|---|---|
| Knee MRI (without contrast) CPT 73721 | $2,439.00 | $4,878.00 | $198.40 – $892.48 | 62 |
| Knee X-ray CPT 73564 | $242.50 | $485.00 | $45.08 – $284.03 | 66 |
| Kras gene variants exon 2 CPT 81275 | $572.50 | $1,145.00 | $82.94 – $836.00 | 71 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $13.12 | $26.25 | $10.71 – $12.91 | 6 |
| Lactate dehydrogenase (ldh) CPT 83615 | $176.00 | $352.00 | $3.54 – $26.10 | 71 |
| Lactic acid CPT 83605 | $370.50 | $741.00 | $6.27 – $50.04 | 71 |
| Lactoferrin fecal qualitative CPT 83630 | $51.50 | $103.00 | $6.77 – $85.22 | 71 |
| Laryngeal function studies CPT 92520 | $431.00 | $862.00 | $58.04 – $361.46 | 60 |
| Laryngoscopic sensory vid CPT 92614 | $432.00 | $864.00 | $54.15 – $146.21 | 56 |
| Laryngoscopy telescopic CPT 31579 | $411.50 | $823.00 | $370.98 – $1,062.58 | 59 |
| Lead capillary CPT 83655 | $9.00 | $18.00 | $7.10 – $52.42 | 71 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,714.00 | $3,428.00 | $73.97 – $789.66 | 66 |
| Leishmania antibody CPT 86717 | $29.00 | $58.00 | $7.19 – $52.99 | 71 |
| Leukocyte phagocytosis CPT 86344 | $151.00 | $302.00 | $4.69 – $44.92 | 71 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $7.75 | $15.50 | $3.06 – $13.15 | 6 |
| Levetiracetam therapeutic drug level CPT 80177 | $95.00 | $190.00 | $7.60 – $57.32 | 71 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $20.75 | $41.50 | $1.53 – $2.39 | 6 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $12.50 | $25.00 | $30.60 – $47.80 | 6 |
| Lidocaine therapeutic drug level CPT 80176 | $74.50 | $149.00 | $8.62 – $63.52 | 71 |
| Lipase CPT 83690 | $158.50 | $317.00 | $4.04 – $29.78 | 71 |
| Lipoprotein blood high res frac & quant CPT 83701 | $22.50 | $45.00 | $14.57 – $146.51 | 71 |
| Lipoprotein blood quant CPT 83704 | $37.50 | $75.00 | $18.51 – $147.88 | 71 |
| Lipoprotein direct measurement hdl CPT 83718 | $221.00 | $442.00 | $4.80 – $35.40 | 71 |
| Lipoprotein direct measurement ldl CPT 83721 | $239.00 | $478.00 | $5.60 – $45.42 | 71 |
| Listeria monocytogenes CPT 86723 | $45.50 | $91.00 | $7.74 – $57.03 | 71 |
| Lithium therapeutic drug level CPT 80178 | $275.00 | $550.00 | $3.88 – $28.62 | 71 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | $1,298.00 | $2,596.00 | $5,635.00 – $5,635.00 | 3 |
| Liver Function Test CPT 80076 | $288.00 | $576.00 | $4.80 – $35.33 | 71 |
| Liver imaging CPT 78201 | $1,391.50 | $2,783.00 | $170.15 – $1,475.12 | 66 |
| Liver/spleen imag static only CPT 78215 | $892.50 | $1,785.00 | $175.22 – $1,086.09 | 66 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $1,200.50 | $2,401.00 | $122.21 – $1,086.09 | 66 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $89.62 | $179.25 | $16.01 – $16.01 | 1 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $4.50 | $9.00 | $0.88 – $2.49 | 6 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $2,943.00 | $5,886.00 | $166.31 – $748.12 | 62 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $2,602.00 | $5,204.00 | $165.06 – $1,370.84 | 62 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $2,263.00 | $4,526.00 | $99.51 – $447.65 | 62 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $3,191.50 | $6,383.00 | $312.67 – $1,406.54 | 62 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,824.00 | $5,648.00 | $265.05 – $1,370.84 | 62 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,455.00 | $4,910.00 | $187.28 – $842.48 | 62 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $467.00 | $934.00 | $38.10 – $284.03 | 66 |
| L/s ratio fetal lung CPT 83661 | $76.50 | $153.00 | $12.90 – $95.10 | 71 |
| Lumbar diskogram s&i CPT 72295 | $1,718.00 | $3,436.00 | $106.02 – $5,305.11 | 66 |
| Lung function test (mbc/mvv) CPT 94200 | $127.50 | $255.00 | $56.75 – $160.27 | 60 |
| Lung Function Test (Spirometry) CPT 94010 | $189.50 | $379.00 | $149.48 – $586.61 | 60 |
| Lung perfusion imaging CPT 78580 | $825.50 | $1,651.00 | $210.14 – $1,086.09 | 66 |
| Lymphatics/lymph node imaging CPT 78195 | $2,071.50 | $4,143.00 | $313.30 – $1,475.12 | 66 |
| Lymphocyte transformation mitogen CPT 86353 | $272.50 | $545.00 | $28.77 – $212.12 | 71 |
| Lymphocytotoxicity assay CPT 86805 | $624.50 | $1,249.00 | $30.68 – $819.85 | 71 |
| Lymph vessel x-ray arm/leg CPT 75801 | $800.50 | $1,601.00 | $270.42 – $2,530.85 | 66 |
| Lymph vessel x-ray arms/legs CPT 75803 | $946.00 | $1,892.00 | $284.62 – $6,586.12 | 66 |
| Lymph vessel x-ray trunk CPT 75805 | $849.00 | $1,698.00 | $297.72 – $13,407.79 | 66 |
| Lymph vessel x-ray trunk CPT 75807 | $2,516.50 | $5,033.00 | $139.21 – $13,407.79 | 66 |
| Macro exam dissect molec study ea CPT 88387 | $37.50 | $75.00 | $2.71 – $114.23 | 19 |
| Macroscopic exam arthropod CPT 87168 | $12.50 | $25.00 | $2.50 – $18.46 | 71 |
| Macroscopic exam parasite CPT 87169 | $12.50 | $25.00 | $2.50 – $18.67 | 71 |
| Magnesium CPT 83735 | $169.50 | $339.00 | $3.93 – $28.98 | 71 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $27.00 | $54.00 | $0.33 – $1.44 | 6 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $59.50 | $119.00 | $123.15 – $361.46 | 60 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $86.00 | $172.00 | $22.06 – $361.46 | 60 |
| Map tachycard site(s) CPT 93609 | $4,127.00 | $8,254.00 | $651.79 – $13,792.00 | 6 |
| Mastoids complete CPT 70130 | $524.50 | $1,049.00 | $59.04 – $284.03 | 66 |
| Matrion 1 sq cm HCPCS Q4201 | $98.12 | $196.25 | $4.22 – $338.09 | 54 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | $26.17 | $52.35 | $125.22 – $338.09 | 53 |
| M.avium-intra dna amp prob CPT 87561 | $141.00 | $282.00 | $20.60 – $151.77 | 71 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $11.50 | $23.00 | $8.48 – $62.58 | 71 |
| Mayo aathr protein s free CPT 85306 | $45.50 | $91.00 | $8.99 – $66.26 | 71 |
| Mayo activated protein c resistance assay CPT 85307 | $16.00 | $32.00 | $8.99 – $66.26 | 71 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $244.00 | $488.00 | $16.20 – $166.84 | 71 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $57.50 | $115.00 | $0.06 – $183.09 | 44 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $132.50 | $265.00 | $0.06 – $183.09 | 44 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $13.00 | $26.00 | $8.68 – $63.95 | 71 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $102.00 | $204.00 | $0.06 – $183.09 | 44 |
| Mayo alpha 1 antitrypsin CPT 82103 | $21.00 | $42.00 | $7.88 – $58.11 | 71 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $292.00 | $584.00 | $8.85 – $65.25 | 71 |
| Mayo amphu amphetamines definitive assay 3 or 4 urine CPT 80325 | $29.50 | $59.00 | $0.06 – $183.09 | 44 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $38.50 | $77.00 | $0.06 – $183.09 | 44 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $217.50 | $435.00 | $69.59 – $526.19 | 71 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $225.00 | $450.00 | $52.53 – $396.55 | 71 |
| Mayo analysis gene smn1 dosage/deletion CPT 81329 | $292.50 | $585.00 | $57.54 – $592.66 | 71 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $1,472.00 | $2,944.00 | $487.20 – $5,018.16 | 71 |
| Mayo androstenedione CPT 82157 | $51.00 | $102.00 | $17.18 – $126.68 | 71 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $12.50 | $25.00 | $8.56 – $63.16 | 71 |
| Mayo antithrombin iii antigen CPT 85301 | $203.00 | $406.00 | $6.35 – $46.79 | 71 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $9.00 | $18.00 | $8.83 – $65.11 | 71 |
| Mayo avwpr vw factor activity CPT 85397 | $120.00 | $240.00 | $14.07 – $133.53 | 71 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | $54.50 | $109.00 | $14.74 – $151.77 | 71 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $101.50 | $203.00 | $0.06 – $183.09 | 44 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $24.50 | $49.00 | $5.97 – $44.05 | 71 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $195.00 | $390.00 | $82.99 – $626.55 | 71 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | $161.00 | $322.00 | $92.16 – $928.43 | 71 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $10.00 | $20.00 | $7.57 – $55.81 | 71 |
| Mayo bnzu sedative hypnotics definitive urine CPT 80368 | $48.50 | $97.00 | $0.06 – $183.09 | 44 |
| Mayo bordetella pertussis antibody igg CPT 86615 | $23.50 | $47.00 | $7.74 – $57.03 | 71 |
| Mayo brcmg brucella antibody igm CPT 86622 | $33.50 | $67.00 | $5.24 – $38.65 | 71 |
| Mayo c1 esterase inhibitor CPT 83883 | $97.50 | $195.00 | $7.98 – $58.83 | 71 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $105.50 | $211.00 | $0.06 – $183.09 | 44 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $23.50 | $47.00 | $9.90 – $72.97 | 71 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | $73.00 | $146.00 | $15.71 – $115.86 | 71 |
| Mayo cdcom hla class ii typing low resolution one locus each CPT 81376 | $779.50 | $1,559.00 | $70.03 – $528.71 | 71 |
| Mayo ceruloplasmin CPT 82390 | $53.50 | $107.00 | $6.30 – $46.43 | 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.