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 |
|---|---|---|---|---|
| MRI w/cont, breast, uni HCPCS C8903 | $2,167.00 | $4,334.00 | $170.07 – $476.52 | 59 |
| MRI without fol w/cont, breast HCPCS C8908 | $3,248.00 | $6,496.00 | $341.19 – $947.81 | 59 |
| MRI without fol w/cont, brst, un HCPCS C8905 | $2,817.50 | $5,635.00 | $341.19 – $947.81 | 59 |
| Mr safety determination physician/other qhp CPT 76016 | $81.00 | $162.00 | $84.12 – $236.43 | 63 |
| Mr safety implant&/fb assmt clin staff ea add 30 CPT 76015 | $22.50 | $45.00 | $91.06 – $230.58 | 6 |
| Mr sfty implt&/fb asmt stf 1 CPT 76014 | $22.50 | $45.00 | $23.40 – $78.58 | 63 |
| Mr spectroscopy CPT 76390 | $1,880.00 | $3,760.00 | $84.12 – $1,336.49 | 59 |
| Msh2 gene dup/delete variant CPT 81297 | $200.50 | $401.00 | $63.72 – $922.74 | 71 |
| Msh2 gene full seq CPT 81295 | $351.00 | $702.00 | $63.72 – $1,651.23 | 71 |
| Msh6 gene dup/delete variant CPT 81300 | $401.50 | $803.00 | $67.91 – $1,029.59 | 71 |
| Msh6 gene full seq CPT 81298 | $590.50 | $1,181.00 | $120.89 – $2,776.64 | 71 |
| Mthfr gene analy common variants CPT 81291 | $94.00 | $188.00 | $25.01 – $282.63 | 71 |
| Mucin synovial fluid CPT 83872 | $12.50 | $25.00 | $3.44 – $25.38 | 71 |
| Multiple sleep latency test CPT 95805 | $2,061.50 | $4,123.00 | $347.51 – $2,333.00 | 63 |
| Mumps antibody igg CPT 86735 | $54.50 | $109.00 | $7.66 – $56.45 | 71 |
| Muscle test cran nerv unilat CPT 95867 | $236.00 | $472.00 | $37.11 – $586.61 | 60 |
| Muscle test larynx CPT 95865 | $258.50 | $517.00 | $36.31 – $361.46 | 60 |
| Mycobacteria dna amp probe CPT 87551 | $213.50 | $427.00 | $20.60 – $208.66 | 71 |
| Mycophenolic acid HCPCS J7518 | $14.25 | $28.50 | $0.98 – $9.42 | 6 |
| Mycoplasma antibody igm CPT 86738 | $66.00 | $132.00 | $7.77 – $57.25 | 71 |
| Myd88 gene p.leu265pro vrnt CPT 81305 | $240.00 | $480.00 | $73.67 – $758.78 | 71 |
| Myeloperoxidase ab multi step qualitative/semiquantitative CPT 83516 | $121.50 | $243.00 | $6.77 – $49.89 | 71 |
| Myocrd img pet 1std rst/strs CPT 78491 | $1,680.00 | $3,360.00 | $1,393.48 – $6,452.95 | 63 |
| Myocrd img pet mlt rst&strs CPT 78492 | $1,680.00 | $3,360.00 | $1,393.48 – $6,452.95 | 63 |
| Nafcillin 2 gram solution for injection HCPCS J2290 | $7.00 | $14.00 | $0.09 – $0.53 | 6 |
| Naloxone 0.4 mg/ml injection (wrapper) HCPCS J2312 | $69.37 | $138.75 | $4.28 – $6.69 | 6 |
| Natriuretic peptide CPT 83880 | $389.00 | $778.00 | $19.92 – $169.87 | 71 |
| Natural killer cells total count CPT 86357 | $109.00 | $218.00 | $22.13 – $163.23 | 71 |
| Ndl emg musc 1 xtr/non-limb CPT 95870 | $141.50 | $283.00 | $28.31 – $361.46 | 60 |
| Neck (Cervical Spine) CT scan (with and without contrast) CPT 72127 | $2,745.50 | $5,491.00 | $166.31 – $748.12 | 62 |
| Neck (Cervical Spine) CT scan (with contrast) CPT 72126 | $2,429.00 | $4,858.00 | $164.74 – $1,370.84 | 62 |
| Neck (Cervical Spine) CT scan (without contrast) CPT 72125 | $2,112.50 | $4,225.00 | $99.51 – $447.65 | 62 |
| Neck (Cervical Spine) MRI (with and without contrast) CPT 72156 | $3,146.00 | $6,292.00 | $313.30 – $1,409.36 | 62 |
| Neck (Cervical Spine) MRI (with contrast) CPT 72142 | $2,783.00 | $5,566.00 | $269.81 – $1,370.84 | 62 |
| Neck (Cervical Spine) MRI (without contrast) CPT 72141 | $2,419.00 | $4,838.00 | $186.66 – $839.66 | 62 |
| Neck MRA (blood vessel MRI, with and without contrast) CPT 70549 | $2,644.00 | $5,288.00 | $338.38 – $1,522.18 | 62 |
| Neck MRA (blood vessel MRI, with contrast) CPT 70548 | $2,338.50 | $4,677.00 | $240.92 – $1,370.84 | 62 |
| Neck MRA (blood vessel MRI, without contrast) CPT 70547 | $2,034.00 | $4,068.00 | $211.41 – $951.02 | 62 |
| Neisseria meningitidis CPT 86741 | $39.50 | $79.00 | $7.74 – $57.03 | 71 |
| Nerve conduction studies 3-4 CPT 95908 | $369.50 | $739.00 | $75.87 – $586.61 | 60 |
| Nerve conduction studies 5-6 CPT 95909 | $389.00 | $778.00 | $25.45 – $586.61 | 60 |
| Nerve teasing preparations CPT 88362 | $109.00 | $218.00 | $14.62 – $2,188.85 | 75 |
| Neuromuscular junction testing ea nerve any 1 method CPT 95937 | $226.00 | $452.00 | $129.47 – $349.58 | 60 |
| New Patient Office Visit (level 2) CPT 99202 | $195.00 | $390.00 | $17.13 – $214.34 | 60 |
| New Patient Office Visit (level 3) CPT 99203 | $211.00 | $422.00 | $34.25 – $214.34 | 60 |
| New Patient Office Visit (level 4) CPT 99204 | $321.00 | $642.00 | $52.81 – $314.44 | 60 |
| New Patient Office Visit (level 5) CPT 99205 | $367.50 | $735.00 | $74.45 – $430.76 | 60 |
| N-invas est c ffr sw aly cta CPT 75580 | $983.50 | $1,967.00 | $864.07 – $3,843.00 | 62 |
| Nm imaging bone/joint 3 phase study CPT 78315 | $1,514.50 | $3,029.00 | $306.64 – $1,379.40 | 66 |
| Nm imaging bone/joint whole body CPT 78306 | $1,213.00 | $2,426.00 | $261.88 – $1,178.03 | 66 |
| Nm imaging cardiac blood pooling planar single study at rest or stress CPT 78472 | $914.00 | $1,828.00 | $202.20 – $1,086.09 | 66 |
| Nm imaging gastric emptying study CPT 78264 | $888.50 | $1,777.00 | $292.68 – $1,316.58 | 66 |
| Nm imaging gastrointestinal acute blood loss CPT 78278 | $655.50 | $1,311.00 | $308.54 – $1,387.95 | 66 |
| Nm imaging hepatobiliary system w/pharmacologic intervention CPT 78227 | $1,162.50 | $2,325.00 | $386.94 – $1,762.92 | 66 |
| Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention CPT 78708 | $1,098.00 | $2,196.00 | $165.06 – $1,475.12 | 66 |
| Nm imaging pulmonary ventilation/perfusion CPT 78582 | $1,932.00 | $3,864.00 | $293.93 – $1,475.12 | 66 |
| Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s) CPT 78014 | $816.00 | $1,632.00 | $207.28 – $1,086.09 | 66 |
| Nm radiopharmaceutical therapy oral administration CPT 79005 | $1,672.50 | $3,345.00 | $85.89 – $633.92 | 66 |
| Noninv pace analysis CPT 93724 | $199.50 | $399.00 | $35.92 – $834.42 | 60 |
| Npm1 gene CPT 81310 | $202.00 | $404.00 | $103.80 – $1,066.43 | 71 |
| Nras gene variants exon 2&3 CPT 81311 | $260.50 | $521.00 | $124.23 – $1,279.56 | 68 |
| Nr lnr acclrtr tx max 5 sessions CPT 77373 | $2,921.00 | $5,842.00 | $1,677.53 – $5,060.63 | 63 |
| Nuclear rx intra-arterial CPT 79445 | $1,910.00 | $3,820.00 | $191.41 – $861.02 | 66 |
| Nuclear rx intra-articular CPT 79440 | $1,669.00 | $3,338.00 | $66.38 – $633.92 | 66 |
| Nuclear rx intracav admin CPT 79200 | $1,669.00 | $3,338.00 | $89.54 – $633.92 | 66 |
| Nuclear rx IV admin CPT 79101 | $1,672.50 | $3,345.00 | $85.26 – $633.92 | 66 |
| Nuclear Stress Test (Heart) CPT 78452 | $4,548.50 | $9,097.00 | $416.15 – $3,517.27 | 66 |
| Nuclr rx interstit colloid CPT 79300 | $1,669.00 | $3,338.00 | $116.32 – $633.92 | 63 |
| Nudt15 gene common variants CPT 81306 | $304.50 | $609.00 | $122.37 – $1,260.45 | 68 |
| Observation direct referral from physician office for admission HCPCS G0379 | $126.50 | $253.00 | $245.70 – $1,617.92 | 60 |
| Observation per hour HCPCS G0378 | $30.50 | $61.00 | $166.02 – $166.02 | 1 |
| Octreotide acetate 100 mcg/ml injection (wrapper) HCPCS J2354 | $92.50 | $185.00 | $4.04 – $5.93 | 6 |
| Oncoprotein dcp CPT 83951 | $129.00 | $258.00 | $39.50 – $278.67 | 71 |
| Ondansetron hcl (pf) 2 mg/ml injection (wrapper) HCPCS J2405 | $1.75 | $3.50 | $0.55 – $5.64 | 6 |
| Opps service,sched team conf HCPCS G0175 | $101.00 | $202.00 | $6.42 – $1,133.61 | 60 |
| Opscpy extnd rta draw uni/bi CPT 92201 | $71.00 | $142.00 | $56.75 – $160.27 | 59 |
| Oral aprepitant HCPCS J8501 | $170.50 | $341.00 | $34.27 – $139.19 | 6 |
| Ortho elbow without jnt cstm w/fit&adj HCPCS L3702 | $202.50 | $405.00 | $324.71 – $876.72 | 53 |
| Ortho ewh rgd without jnt cstm w/fit&adj HCPCS L3763 | $676.00 | $1,352.00 | $787.21 – $2,125.47 | 52 |
| Ortho hnd/fngr without jnt cstm w/fit&adj HCPCS L3913 | $261.50 | $523.00 | $304.55 – $822.29 | 52 |
| Ortho hnd/fngr w/jnt cstm w/fit&adj HCPCS L3921 | $310.00 | $620.00 | $361.14 – $975.08 | 52 |
| Ortho hnd without jnt w/fit&adj HCPCS L3919 | $261.50 | $523.00 | $304.55 – $822.29 | 52 |
| Ortho whf rigd without jnt cstm w/fit&adj HCPCS L3808 | $322.50 | $645.00 | $375.75 – $1,014.53 | 52 |
| Ortho wrst/hnd w/jnt cstm w/fit&adj HCPCS L3905 | $957.50 | $1,915.00 | $1,115.05 – $3,010.64 | 52 |
| Oscillation chest wall mechanical per session CPT 94669 | $234.50 | $469.00 | $91.31 – $594.91 | 60 |
| Osmolality blood CPT 83930 | $184.00 | $368.00 | $3.88 – $28.62 | 71 |
| Osmolality urine CPT 83935 | $184.00 | $368.00 | $4.00 – $29.49 | 71 |
| Ot evaluation high complexity patient/family CPT 97167 | $481.50 | $963.00 | $34.02 – $273.40 | 56 |
| Ot evaluation low complexity patient/family CPT 97165 | $445.50 | $891.00 | $53.04 – $273.40 | 56 |
| Ot evaluation moderate complexity patient/family CPT 97166 | $463.50 | $927.00 | $101.26 – $273.40 | 56 |
| Oth resp proc, group HCPCS G0239 | $38.00 | $76.00 | $37.50 – $422.42 | 60 |
| Oth resp proc, indiv HCPCS G0238 | $110.50 | $221.00 | $23.40 – $78.58 | 60 |
| Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes CPT 97763 | $112.00 | $224.00 | $17.13 – $135.84 | 56 |
| Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes CPT 97760 | $112.00 | $224.00 | $10.71 – $125.04 | 56 |
| Ot manual therpy techniques >=1 region each 15 minutes CPT 97140 | $112.00 | $224.00 | $18.03 – $75.30 | 56 |
| Ot re-evaluation patient/family CPT 97168 | $427.50 | $855.00 | $26.88 – $186.06 | 56 |
| Ot therapeutic activities direct patient contact each 15 minutes CPT 97530 | $112.00 | $224.00 | $35.25 – $95.18 | 56 |
| Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes CPT 97130 | $112.00 | $224.00 | $18.03 – $49.98 | 56 |
| Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes CPT 97129 | $112.00 | $224.00 | $18.03 – $53.46 | 56 |
| Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes CPT 97110 | $112.00 | $224.00 | $15.94 – $78.95 | 56 |
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.