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 |
|---|---|---|---|---|
| Mayo selenium CPT 84255 | $33.00 | $66.00 | $14.98 – $110.46 | 71 |
| Mayo serotonin CPT 84260 | $28.00 | $56.00 | $18.18 – $134.03 | 71 |
| Mayo sfgp rickettsia rickettsii antibody igg CPT 86757 | $13.50 | $27.00 | $11.36 – $83.71 | 71 |
| Mayo sirolimus therapeutic drug level CPT 80195 | $107.50 | $215.00 | $8.05 – $59.41 | 71 |
| Mayo streptococcus pneumoniae antibody igg 23 serotypes multiplex immunoassay quantitative CPT 86581 | $27.00 | $54.00 | $23.68 – $248.48 | 59 |
| Mayo syphilis test non-treponemal antibody qualitative vdrl CPT 86592 | $97.00 | $194.00 | $2.50 – $18.46 | 71 |
| Mayo tau phosphorylated 217 each CPT 84393 | $249.00 | $498.00 | $27.29 – $1,081.75 | 59 |
| Mayo tcgr analysis gene rearrangement trb@ abnormal clonal population(s) amplification CPT 81340 | $1,255.00 | $2,510.00 | $119.71 – $903.77 | 71 |
| Mayo tgrp testosterone free CPT 84402 | $8.00 | $16.00 | $14.94 – $110.17 | 71 |
| Mayo tgrp testosterone total CPT 84403 | $26.50 | $53.00 | $15.15 – $111.68 | 71 |
| Mayo thiopurine s-methyltransferase CPT 84433 | $98.00 | $196.00 | $9.31 – $95.89 | 71 |
| Mayo thyroglobulin CPT 84432 | $52.00 | $104.00 | $9.42 – $69.50 | 71 |
| Mayo ticks anaplasma phagocytophilum antibody igg CPT 86666 | $68.50 | $137.00 | $5.97 – $44.05 | 71 |
| Mayo ticks babesia microti antibody igg CPT 86753 | $13.50 | $27.00 | $7.27 – $53.57 | 71 |
| Mayo tramadol definitive assay w metabolite quantitative urine CPT 80373 | $75.00 | $150.00 | $0.06 – $183.09 | 44 |
| Mayo tulab francisella tularensis antibody igg CPT 86668 | $19.00 | $38.00 | $6.10 – $61.29 | 71 |
| Mayo vasoactive intestinal peptide CPT 84586 | $21.50 | $43.00 | $20.74 – $152.85 | 71 |
| Mayo vitamin b-2 (riboflavin) CPT 84252 | $132.00 | $264.00 | $11.88 – $87.53 | 71 |
| Mayo vitamin b3 (niacin) CPT 84591 | $79.00 | $158.00 | $6.80 – $73.83 | 71 |
| Mayo vitamin k CPT 84597 | $41.50 | $83.00 | $8.04 – $59.34 | 71 |
| Mcoln1 gene CPT 81290 | $36.00 | $72.00 | $16.51 – $170.08 | 71 |
| #mec-opiates CPT 80356 | $82.50 | $165.00 | $0.06 – $57.09 | 18 |
| Mecp2 gene dup/delet variant CPT 81304 | $431.50 | $863.00 | $63.00 – $648.90 | 71 |
| Medroxyprogesterone 150 mg/ml im injection (wrapper) HCPCS J1050 | $77.00 | $154.00 | $75.29 – $136.50 | 6 |
| Membrane amnioband 2x2cm -cost per sq cm HCPCS Q4151 | $163.78 | $327.57 | $125.22 – $338.09 | 53 |
| Membrane placenta tiss enverse sheet 2x3cm-cost per sq cm HCPCS Q4258 | $103.12 | $206.25 | $54.56 – $338.09 | 54 |
| Memoderm/derma/tranz/integup HCPCS Q4126 | $128.43 | $256.86 | $125.22 – $338.09 | 53 |
| Meperidine (pf) 25 mg/ml injection (wrapper) HCPCS J2175 | $5.50 | $11.00 | $1.09 – $3.60 | 6 |
| Meropenem 1 gram intravenous solution HCPCS J2185 | $47.50 | $95.00 | $2.98 – $26.41 | 6 |
| Metabolic Blood Panel (Basic) CPT 80048 | $349.50 | $699.00 | $4.97 – $36.63 | 71 |
| Metabolic Blood Panel (Comprehensive) CPT 80053 | $405.00 | $810.00 | $6.20 – $45.71 | 71 |
| Metabolic panel ionized ca CPT 80047 | $137.00 | $274.00 | $10.95 – $59.41 | 71 |
| Metered dose inhaler drug HCPCS J3535 | $47.75 | $95.50 | not published | 0 |
| Methocarbamol ivpb 250 mg in 50 ml ns - cnr (headpain) HCPCS J2800 | $110.50 | $221.00 | $7.01 – $30.09 | 6 |
| Methotrexate sodium (pf) 1 gram solution for injection HCPCS J9260 | $64.62 | $129.25 | $2.84 – $4.55 | 6 |
| Methotrexate therapeutic drug level CPT 80204 | $60.00 | $120.00 | $16.20 – $166.84 | 71 |
| Methylene blue (antidote) 5 mg/ml intravenous solution HCPCS Q9968 | $1,530.00 | $3,060.00 | $2.77 – $26.48 | 58 |
| Methylergonovine 0.2 mg/ml (1 ml) injection solution HCPCS J2210 | $66.75 | $133.50 | $32.65 – $37.77 | 6 |
| Methylnaltrexone 12 mg/0.6 ml subcutaneous injection (wrapper) HCPCS J2212 | $347.37 | $694.75 | $275.33 – $315.00 | 6 |
| Methylphenidate CPT 80360 | $75.00 | $150.00 | $0.06 – $183.09 | 44 |
| Methylprednisolone 4 mg tablet HCPCS J7509 | $60.75 | $121.50 | $4.50 – $18.57 | 6 |
| Methylprednisolone acetate 40 mg/ml suspension for injection HCPCS J1010 | $20.25 | $40.50 | $0.12 – $14.67 | 10 |
| Methylprednisolone sodium succinate 1,000 mg intravenous solution HCPCS J2919 | $68.25 | $136.50 | $0.27 – $5.87 | 10 |
| Mgmt promoter methylation analysis CPT 81287 | $240.00 | $480.00 | $34.90 – $539.16 | 71 |
| Microalbumin urine screen CPT 82044 | $55.00 | $110.00 | $2.68 – $26.97 | 71 |
| Microbe susceptible mlc CPT 87187 | $90.00 | $180.00 | $6.08 – $173.76 | 71 |
| Microdissection laser CPT 88380 | $911.00 | $1,822.00 | $5.29 – $330.36 | 16 |
| Microdissection manual CPT 88381 | $213.00 | $426.00 | $44.39 – $840.40 | 16 |
| Microsatellite instability CPT 81301 | $480.00 | $960.00 | $165.92 – $1,507.90 | 71 |
| Midazolam 1 mg/ml injection solution HCPCS J2250 | $10.62 | $21.25 | $0.38 – $0.49 | 6 |
| Midazolam 1 mg/ml in sodium chloride IV infusion (wrapper) HCPCS J2251 | $46.25 | $92.50 | $13.77 – $40.63 | 6 |
| Milrinone 20 mg/100 ml(200 mcg/ml) in 5 % dextrose intravenous piggybk HCPCS J2260 | $31.87 | $63.75 | $8.32 – $16.83 | 6 |
| Mlh1 gene CPT 81288 | $210.50 | $421.00 | $67.05 – $831.96 | 71 |
| Mlh1 gene dup/delete variant CPT 81294 | $186.00 | $372.00 | $80.09 – $875.58 | 71 |
| Mlh1 gene full seq CPT 81292 | $621.50 | $1,243.00 | $271.42 – $2,921.78 | 71 |
| Mog-igg1 antb flo cytmtry ea CPT 86363 | $350.00 | $700.00 | $5.06 – $135.43 | 71 |
| Mopath procedure level 1 CPT 81400 | $174.00 | $348.00 | $26.86 – $276.72 | 71 |
| Mopath procedure level 3 CPT 81402 | $265.00 | $530.00 | $63.14 – $650.34 | 71 |
| Mopath procedure level 5 CPT 81404 | $747.50 | $1,495.00 | $115.43 – $1,188.93 | 71 |
| Mopath procedure level 6 CPT 81405 | $1,840.00 | $3,680.00 | $126.57 – $1,303.64 | 71 |
| Mopath procedure level 7 CPT 81406 | $1,050.00 | $2,100.00 | $118.81 – $1,223.75 | 71 |
| Mopath procedure level 8 CPT 81407 | $900.00 | $1,800.00 | $355.43 – $3,660.95 | 71 |
| Mopath procedure level 9 CPT 81408 | $1,840.00 | $3,680.00 | $840.00 – $8,652.00 | 71 |
| Morphine 4 mg/ml injection (wrapper) HCPCS J2270 | $21.00 | $42.00 | $0.03 – $1.07 | 6 |
| Morphine (pf) 0.25 mg/0.5 ml injection (neo/ped) - cnr HCPCS J2274 | $60.87 | $121.75 | $11.14 – $23.85 | 6 |
| Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain computer-assisted CPT 88361 | $137.00 | $274.00 | $14.62 – $973.82 | 75 |
| Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain manual CPT 88360 | $378.00 | $756.00 | $14.62 – $462.86 | 75 |
| Motor &/ sens nrve cndj test CPT 95905 | $141.50 | $283.00 | $66.36 – $1,213.65 | 60 |
| M/phmtrc alys ishquant/semiq CPT 88373 | $115.00 | $230.00 | $16.52 – $225.04 | 19 |
| M/phmtrc alys ishquant/semiq CPT 88377 | $1,126.00 | $2,252.00 | $77.15 – $1,543.73 | 75 |
| M/phmtrc alysishquant/semiq CPT 88369 | $199.00 | $398.00 | $20.42 – $447.78 | 19 |
| MRA abdomen post contrast CPT 74185 | $2,793.50 | $5,587.00 | $230.93 – $1,111.39 | 59 |
| MRA aorta thoracic w/wo contrast CPT 71555 | $2,523.50 | $5,047.00 | $230.93 – $1,098.43 | 59 |
| MRA ext low(run-off)pst cntrst CPT 73725 | $3,325.50 | $6,651.00 | $230.93 – $1,620.16 | 62 |
| MRA pelvis CPT 72198 | $2,444.50 | $4,889.00 | $230.93 – $1,107.48 | 59 |
| MRA upper extremity post contrast-bil CPT 73225 | $2,444.50 | $4,889.00 | $230.93 – $1,104.89 | 59 |
| Mr elastography CPT 76391 | $604.00 | $1,208.00 | $196.80 – $885.30 | 62 |
| MRI breast c- unilateral CPT 77046 | $1,880.00 | $3,760.00 | $230.93 – $836.61 | 59 |
| MRI breast c-+ w/cad uni CPT 77048 | $1,880.00 | $3,760.00 | $332.87 – $1,057.04 | 55 |
| MRI breast without cont bi CPT 77047 | $1,880.00 | $3,760.00 | $230.93 – $836.61 | 59 |
| MRI breast w IV cont bi CPT 77049 | $1,880.00 | $3,760.00 | $338.56 – $1,051.87 | 55 |
| MRI cardiac morph & func wo IV cont CPT 75557 | $1,880.00 | $3,760.00 | $221.80 – $997.73 | 62 |
| MRI cardiac morph & func wwo IV cont CPT 75561 | $2,683.00 | $5,366.00 | $341.19 – $1,565.90 | 62 |
| MRI cardiac morph & func wwo IV cont w/stress img CPT 75563 | $2,193.00 | $4,386.00 | $414.87 – $2,129.73 | 62 |
| MRI chest without contrast CPT 71550 | $2,095.00 | $4,190.00 | $221.80 – $997.73 | 62 |
| MRI chest without & w/contrast CPT 71552 | $2,723.50 | $5,447.00 | $341.19 – $1,565.90 | 62 |
| MRI chest w IV cont CPT 71551 | $2,408.50 | $4,817.00 | $365.99 – $2,444.14 | 62 |
| MRI compatible system HCPCS L0859 | $937.50 | $1,875.00 | $1,866.53 – $5,039.63 | 52 |
| MRI guid ndl plc s&i CPT 77021 | $1,880.00 | $3,760.00 | $691.89 – $691.89 | 1 |
| MRI loex nonjt w IV cont CPT 73719 | $2,645.50 | $5,291.00 | $257.74 – $1,370.84 | 62 |
| MRI lower extremity other than joint without contrast (both sides) CPT 73718 | $2,300.50 | $4,601.00 | $218.70 – $983.80 | 62 |
| MRI lower extremity other than joint without & w/contrast (both sides) CPT 73720 | $2,753.50 | $5,507.00 | $330.13 – $1,485.04 | 62 |
| MRI orbit/face/neck without contrast CPT 70540 | $2,091.00 | $4,182.00 | $221.57 – $996.71 | 62 |
| MRI orbit/face/neck without & w/contrast CPT 70543 | $2,717.50 | $5,435.00 | $331.70 – $1,492.14 | 62 |
| MRI orbit fac&nck w IV cont CPT 70542 | $2,404.00 | $4,808.00 | $262.83 – $1,370.84 | 62 |
| MRI tmj CPT 70336 | $1,890.00 | $3,780.00 | $221.80 – $997.73 | 62 |
| MRI upper extremity other than joint without contrast (both sides) CPT 73218 | $1,906.00 | $3,812.00 | $221.80 – $997.73 | 62 |
| MRI upper extremity other than joint without & w/contrast (both sides) CPT 73220 | $2,478.50 | $4,957.00 | $341.19 – $1,565.90 | 62 |
| MRI upper extremity w/dye CPT 73219 | $2,192.00 | $4,384.00 | $324.72 – $1,460.73 | 62 |
| MRI w/cont, breast, bi HCPCS C8906 | $2,499.50 | $4,999.00 | $341.19 – $947.81 | 59 |
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.