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 |
|---|---|---|---|---|
| Ot therapeutic procedure neuromuscular reeducate each 15 minutes CPT 97112 | $112.00 | $224.00 | $15.46 – $88.94 | 56 |
| Ot training self care/home management direct contact each 15 minutes CPT 97535 | $112.00 | $224.00 | $32.58 – $87.97 | 56 |
| Oxytocin 10 unit/ml injection solution HCPCS J2590 | $6.75 | $13.50 | $1.29 – $2.35 | 6 |
| Pacemaker leadless 19.5f 32.2mm ra HCPCS C1605 | $17,381.25 | $34,762.50 | $163.03 – $13,209.75 | 53 |
| Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr HCPCS J2470 | $5.62 | $11.25 | $6.69 – $10.97 | 6 |
| Papaverin hcl injection HCPCS J2440 | $78.75 | $157.50 | $55.08 – $63.00 | 6 |
| Parathormone (pth) intact CPT 83970 | $174.50 | $349.00 | $24.22 – $178.59 | 71 |
| Parathyrd planar w/spect&ct CPT 78072 | $1,317.50 | $2,635.00 | $514.24 – $2,102.58 | 63 |
| Parathyroid planar imaging CPT 78070 | $1,400.50 | $2,801.00 | $259.97 – $1,169.44 | 66 |
| Parathyroid planar img w/tomo spect CPT 78071 | $2,100.00 | $4,200.00 | $310.44 – $1,396.49 | 66 |
| Particle matristem matrix 1000mg micron-q4118-cost per mg HCPCS Q4118 | $1.69 | $3.39 | $7.62 – $7.62 | 1 |
| Passy muir valve metal trach HCPCS L8501 | $85.51 | $171.02 | $147.88 – $399.28 | 53 |
| Path clin consltj sf 5-20 CPT 80503 | $129.50 | $259.00 | $21.32 – $141.57 | 72 |
| Pdgfra gene CPT 81314 | $343.00 | $686.00 | $138.39 – $1,425.49 | 71 |
| Pelvic CT scan (with and without contrast) CPT 72194 | $2,545.00 | $5,090.00 | $166.31 – $748.12 | 62 |
| Pelvic CT scan (with contrast) CPT 72193 | $2,251.50 | $4,503.00 | $166.31 – $748.12 | 62 |
| Pelvic CT scan (without contrast) CPT 72192 | $1,958.00 | $3,916.00 | $99.51 – $447.65 | 62 |
| Pelvic MRI (with and without contrast) CPT 72197 | $2,642.00 | $5,284.00 | $329.80 – $1,483.59 | 62 |
| Pelvic MRI (with contrast) CPT 72196 | $2,337.50 | $4,675.00 | $262.83 – $1,370.84 | 62 |
| Pelvic MRI (without contrast) CPT 72195 | $2,032.50 | $4,065.00 | $221.80 – $997.73 | 62 |
| Pelvic Ultrasound (complete) CPT 76856 | $629.50 | $1,259.00 | $91.47 – $411.45 | 66 |
| Pelvic Ultrasound (limited) CPT 76857 | $330.50 | $661.00 | $48.25 – $284.03 | 66 |
| Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe HCPCS J0561 | $755.12 | $1,510.25 | $26.82 – $677.88 | 62 |
| Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr HCPCS J2540 | $94.75 | $189.50 | $41.10 – $120.26 | 6 |
| Penile vascular study CPT 93981 | $1,147.00 | $2,294.00 | $33.30 – $301.28 | 66 |
| Peri-proc device eval icd CPT 93287 | $508.00 | $1,016.00 | $23.93 – $95.57 | 6 |
| Peri-proc device eval pm CPT 93286 | $508.00 | $1,016.00 | $15.17 – $95.57 | 6 |
| Peritoneogram rs&i CPT 74190 | $600.50 | $1,201.00 | $76.99 – $2,262.57 | 66 |
| Perit-vens shunt pat tst CPT 78291 | $703.00 | $1,406.00 | $233.63 – $1,086.09 | 66 |
| Pet CT skull-mid thgh initial CPT 78815 | $7,898.00 | $15,796.00 | $1,393.48 – $6,452.95 | 66 |
| Pet CT whole body initial CPT 78816 | $7,898.00 | $15,796.00 | $1,393.48 – $6,452.95 | 66 |
| Pet fdg brain metoblic eval sb CPT 78608 | $7,898.00 | $15,796.00 | $1,391.28 – $6,452.95 | 66 |
| Pet image w/ct lmtd CPT 78814 | $1,410.00 | $2,820.00 | $1,393.48 – $6,452.95 | 66 |
| Ph body fluid CPT 83986 | $81.50 | $163.00 | $2.10 – $15.50 | 71 |
| Phencyclidine (pcp) CPT 83992 | $97.50 | $195.00 | $0.06 – $183.09 | 45 |
| Phenobarbital therapeutic drug level CPT 80184 | $64.50 | $129.00 | $6.72 – $66.19 | 71 |
| Phenylephrine 10 mg/ml injection solution HCPCS J2371 | $81.00 | $162.00 | $0.77 – $1.20 | 6 |
| Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr HCPCS J1165 | $3.75 | $7.50 | $3.94 – $5.25 | 6 |
| Phenytoin total therapeutic drug level CPT 80185 | $25.00 | $50.00 | $7.78 – $57.32 | 71 |
| Phlebotomy therapeutic CPT 99195 | $134.00 | $268.00 | $6.18 – $361.46 | 60 |
| Phosphorus CPT 84100 | $108.00 | $216.00 | $2.78 – $20.48 | 71 |
| Phosphorus 24 hour urine CPT 84105 | $17.00 | $34.00 | $3.04 – $25.02 | 71 |
| Photopheresis CPT 36522 | $8,204.00 | $16,408.00 | $1,674.15 – $11,832.91 | 66 |
| Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 | $46.25 | $92.50 | $43.45 – $75.29 | 6 |
| Piperacillin-tazobactam 3.375 gram intravenous solution HCPCS J2543 | $22.25 | $44.50 | $6.73 – $22.08 | 6 |
| Placement occlusive device venous/arterial access site post procedure HCPCS G0269 | $85.00 | $170.00 | $9.52 – $9.52 | 1 |
| Placental lactogen CPT 83632 | $109.50 | $219.00 | $11.86 – $87.46 | 71 |
| Plasma cryoprecipitate reduced each unit HCPCS P9044 | $52.00 | $104.00 | $132.05 – $356.54 | 59 |
| Platelet aggregation each agent teg CPT 85576 | $852.00 | $1,704.00 | $12.60 – $107.79 | 71 |
| Platelet automated CPT 85049 | $108.00 | $216.00 | $2.63 – $19.39 | 71 |
| Platelet pheresis each unit HCPCS P9034 | $655.50 | $1,311.00 | $308.96 – $834.19 | 59 |
| Platelets each unit HCPCS P9019 | $68.00 | $136.00 | $53.17 – $143.56 | 59 |
| Platelets hla matched leukocytes reduced apheresis/pheresis each unit HCPCS P9052 | $1,121.50 | $2,243.00 | $708.06 – $1,911.76 | 59 |
| Platelets irradiated ea unit HCPCS P9032 | $253.50 | $507.00 | $135.78 – $1,061.02 | 59 |
| Platelets leukocytes reduced each unit HCPCS P9031 | $568.00 | $1,136.00 | $125.77 – $389.50 | 59 |
| Platelets leukocytes reduced irradiated each unit HCPCS P9033 | $323.00 | $646.00 | $189.59 – $511.89 | 59 |
| Platelets pheresis leukocytes reduced cmv negative irradiated each unit HCPCS P9053 | $317.00 | $634.00 | $459.23 – $1,359.32 | 59 |
| Platelets pheresis leukocytes reduced each unit HCPCS P9035 | $655.50 | $1,311.00 | $487.10 – $1,381.29 | 59 |
| Platelets pheresis leukocytes reduced irradiated each unit HCPCS P9037 | $832.00 | $1,664.00 | $675.66 – $1,837.65 | 59 |
| Plethysmography lung volumes/airway resistance CPT 94726 | $762.00 | $1,524.00 | $2.85 – $1,013.78 | 60 |
| Pms2 gene dup/delet variants CPT 81319 | $401.50 | $803.00 | $93.10 – $880.34 | 71 |
| Pms2 gene full seq analysis CPT 81317 | $622.50 | $1,245.00 | $328.14 – $2,926.54 | 71 |
| #pnh-flow cytometry interp CPT 88187 | $75.00 | $150.00 | $4.95 – $156.53 | 68 |
| Poct blood gases ph pco2 po2 arterial calculated o2 CPT 82803 | $570.50 | $1,141.00 | $11.36 – $112.76 | 71 |
| Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap CPT 95811 | $4,178.00 | $8,356.00 | $219.78 – $2,333.00 | 63 |
| Potassium 24 hour urine CPT 84133 | $134.00 | $268.00 | $2.52 – $20.48 | 71 |
| Potassium chloride 10 meq/100ml in sterile water intravenous piggyback HCPCS J3480 | $22.75 | $45.50 | $0.84 – $1.05 | 6 |
| Potassium serum/plasma/whole blood CPT 84132 | $134.00 | $268.00 | $2.70 – $20.62 | 71 |
| Pq dr cath chg w cont s&i CPT 75984 | $396.50 | $793.00 | $115.71 – $284.94 | 6 |
| Pr counseling smoke/tobacco intermediate greater 3 - 10 minutes CPT 99406 | $25.50 | $51.00 | $8.56 – $101.79 | 60 |
| Pr debridement open wound topical appl/wound asmt per session 20 sq cm/< CPT 97597 | $483.50 | $967.00 | $15.46 – $6,261.00 | 63 |
| Prealbumin CPT 84134 | $122.00 | $244.00 | $8.56 – $63.09 | 71 |
| Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution HCPCS J7510 | $535.75 | $1,071.50 | $1.36 – $4.88 | 6 |
| Pregabalin - sendout CPT 80366 | $79.50 | $159.00 | $0.06 – $183.09 | 44 |
| Pregnancy associated plasma protein-a CPT 84163 | $37.50 | $75.00 | $8.83 – $65.11 | 71 |
| Pregnancy Ultrasound (complete, after first trimester) CPT 76805 | $567.00 | $1,134.00 | $99.51 – $447.65 | 66 |
| Pregnancy Ultrasound (first trimester) CPT 76801 | $531.50 | $1,063.00 | $99.51 – $447.65 | 66 |
| Pressure max expiratory/inspiratory CPT 94799 | $80.00 | $160.00 | $36.31 – $349.58 | 60 |
| Pressure velocity wire add ves CPT 93572 | $450.00 | $900.00 | $192.67 – $192.67 | 1 |
| Pretreatment serum by diff red cell adsorption patient rbc/known phenotype each adsorption ref CPT 86977 | $459.50 | $919.00 | $5.78 – $462.86 | 72 |
| Pretreat rbc absorption reference CPT 86978 | $158.50 | $317.00 | $5.78 – $160.27 | 72 |
| Pretreat rbc density gradient separation reference CPT 86972 | $157.50 | $315.00 | $5.78 – $462.86 | 72 |
| Pretreat rbc w chem/drugs reference CPT 86970 | $387.50 | $775.00 | $5.78 – $160.27 | 72 |
| Pretreat rbc w enzyme reference CPT 86971 | $176.50 | $353.00 | $5.78 – $462.86 | 72 |
| Pr evaluation psychiatric diagnostic w/medical services CPT 90792 | $253.50 | $507.00 | not published | 0 |
| Prgr stim/pace a/iv drug CPT 93623 | $750.00 | $1,500.00 | $651.79 – $651.79 | 1 |
| Procainamide 100 mg/ml injection (wrapper) HCPCS J2690 | $775.00 | $1,550.00 | $183.03 – $930.23 | 62 |
| Procalcitonin CPT 84145 | $170.50 | $341.00 | $11.66 – $117.74 | 71 |
| Prochlorperazine edisylate 10 mg/2 ml (5 mg/ml) injection solution HCPCS J0780 | $9.87 | $19.75 | $3.90 – $29.73 | 6 |
| Progesterone CPT 84144 | $40.50 | $81.00 | $12.24 – $90.27 | 71 |
| Prolactin CPT 84146 | $13.50 | $27.00 | $11.37 – $83.85 | 71 |
| Promethazine hcl injection HCPCS J2550 | $3.50 | $7.00 | $0.72 – $7.02 | 6 |
| Propofol infusion 10 mg/ml HCPCS J2704 | $25.25 | $50.50 | $13.77 – $40.63 | 6 |
| _propoxygc/msur CPT 80367 | $121.00 | $242.00 | $0.06 – $183.09 | 44 |
| Propranolol in ns IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J1800 | $27.50 | $55.00 | $14.31 – $16.63 | 6 |
| Prosthetic sock multi ply bk HCPCS L8420 | $30.25 | $60.51 | $25.45 – $68.72 | 53 |
| Protamine 10 mg/ml intravenous solution HCPCS J2720 | $37.12 | $74.25 | $12.16 – $14.34 | 6 |
| Protein c activity CPT 85303 | $203.00 | $406.00 | $8.11 – $59.84 | 71 |
| Protein electrophoretic fractionation & quantitation serum CPT 84165 | $231.50 | $463.00 | $6.30 – $46.43 | 71 |
| Protein s total CPT 85305 | $203.00 | $406.00 | $6.80 – $50.25 | 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.