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 |
|---|---|---|---|---|
| Protein total 24 hour urine CPT 84156 | $105.50 | $211.00 | $2.15 – $15.86 | 71 |
| Protein total body fluid CPT 84157 | $105.50 | $211.00 | $2.15 – $17.30 | 71 |
| Protein total serum plasma whole blood CPT 84155 | $105.50 | $211.00 | $2.15 – $15.86 | 71 |
| Prothrombin complex kcentra HCPCS J7168 | $3,754.87 | $7,509.75 | $2.09 – $3,118.95 | 62 |
| Prothrombin time substitution plasma fractions each CPT 85611 | $31.50 | $63.00 | $2.31 – $17.02 | 71 |
| Prq card revasc mi 1 vsl CPT 92941 | $15,296.00 | $30,592.00 | $579.18 – $1,563.79 | 56 |
| Prq revasc byp graft 1 art and/or branches CPT 92937 | $15,296.00 | $30,592.00 | $10,834.33 – $31,362.93 | 60 |
| Prq tcat plmt ntrac st 1 les CPT 92928 | $11,381.00 | $22,762.00 | $10,834.33 – $31,362.93 | 60 |
| Prq tcat plmt ntrac st 2+les CPT 92930 | $17,230.50 | $34,461.00 | $18,445.51 – $49,802.88 | 56 |
| Prq trlml c athrc st angiop1 CPT 92933 | $15,296.00 | $30,592.00 | $17,155.13 – $49,802.88 | 60 |
| Prq trluml c angiop 1art&/br CPT 92920 | $5,191.50 | $10,383.00 | $5,447.00 – $15,462.68 | 60 |
| Prq trluml c athrc 1 art&/br CPT 92924 | $3,915.00 | $7,830.00 | $10,834.33 – $31,362.93 | 60 |
| Prq trluml revsc ch occ ant CPT 92943 | $15,296.00 | $30,592.00 | $10,834.33 – $31,362.93 | 60 |
| PSA (Prostate) Test CPT 84153 | $166.00 | $332.00 | $10.79 – $79.53 | 71 |
| Psychotherapy patient individual therapy 30 minutes CPT 90832 | $156.00 | $312.00 | not published | 0 |
| Psychotherapy patient individual therapy 60 minutes CPT 90837 | $172.50 | $345.00 | not published | 0 |
| Psytx pt w/e&m 16-37 min CPT 90833 | $84.50 | $169.00 | not published | 0 |
| Psytx pt w/e&m 38-52 min CPT 90836 | $112.50 | $225.00 | not published | 0 |
| Pt application of modality >=1 area electrical stimulation each 15 minutes CPT 97032 | $127.00 | $254.00 | $14.77 – $39.88 | 56 |
| Pt application of modality >=1 area iontophoresis each 15 minutes CPT 97033 | $127.00 | $254.00 | $7.37 – $51.62 | 56 |
| Pt application of modality >=1 area ultrasound each 15 minutes CPT 97035 | $112.00 | $224.00 | $14.42 – $38.93 | 56 |
| Pt application of modality traction mechanical CPT 97012 | $112.00 | $224.00 | $4.76 – $38.96 | 56 |
| Pten gene dup/delet variant CPT 81323 | $401.50 | $803.00 | $36.79 – $1,297.80 | 71 |
| Pten gene full sequence CPT 81321 | $552.00 | $1,104.00 | $252.29 – $2,595.60 | 71 |
| Pt evaluation high complexity patient/family CPT 97163 | $481.50 | $963.00 | $42.10 – $266.19 | 56 |
| Pt evaluation low complexity patient/family CPT 97161 | $445.50 | $891.00 | $61.37 – $266.19 | 56 |
| Pt evaluation moderate complexity patient/family CPT 97162 | $463.50 | $927.00 | $61.37 – $266.19 | 56 |
| Pt re-evaluation patient/family CPT 97164 | $427.50 | $855.00 | $34.02 – $183.36 | 56 |
| Pt repositioning canalith procedure(s) per day CPT 95992 | $201.50 | $403.00 | $29.83 – $80.54 | 56 |
| Pt stimulation electrial unattended >= 1 area other than wound care part of therapy plan HCPCS G0283 | $138.00 | $276.00 | $12.74 – $320.50 | 56 |
| Pt therapeutic procedure >=1 area gait training each 15 minutes CPT 97116 | $112.00 | $224.00 | $18.79 – $78.95 | 56 |
| Pt therapeutic procedure >=1 area massage each 15 minutes CPT 97124 | $112.00 | $224.00 | $12.37 – $80.62 | 56 |
| Pt wheelchair management each 15 minutes CPT 97542 | $112.00 | $224.00 | $14.98 – $84.40 | 56 |
| Pul art balloon repr percut CPT 92997 | $3,453.00 | $6,906.00 | $10,834.33 – $31,362.93 | 59 |
| Pul art balloon repr percut CPT 92998 | $1,823.50 | $3,647.00 | $167.05 – $167.05 | 1 |
| Pulmonary vent imaging CPT 78579 | $1,108.00 | $2,216.00 | $167.61 – $1,086.09 | 66 |
| Pulse ox continuous overnight monitoring CPT 94762 | $261.00 | $522.00 | $5.71 – $349.58 | 60 |
| Pulse ox multiple CPT 94761 | $44.50 | $89.00 | $22.06 – $22.06 | 1 |
| Puncture arterial withdrawal blood for diagnosis CPT 36600 | $85.00 | $170.00 | $123.15 – $361.46 | 59 |
| Pyruvate kinase CPT 84220 | $39.00 | $78.00 | $5.54 – $40.81 | 71 |
| Quant diff pulm perf and vent w/imaging CPT 78598 | $1,890.00 | $3,780.00 | $267.91 – $1,475.12 | 66 |
| Quant diff pulm perf w/imaging CPT 78597 | $824.50 | $1,649.00 | $178.70 – $1,086.09 | 66 |
| Quest t3 uptake CPT 84479 | $5.50 | $11.00 | $3.80 – $27.97 | 71 |
| Rabies ig ht&sol human im/sc CPT 90377 | $4,288.12 | $8,576.25 | $240.13 – $1,813.25 | 58 |
| Radiation physics consult CPT 77336 | $3,679.50 | $7,359.00 | $126.84 – $404.26 | 63 |
| Radiation therapy dose plan CPT 77300 | $3,679.50 | $7,359.00 | $85.46 – $365.16 | 63 |
| Radiation treatment aid(s) CPT 77332 | $820.00 | $1,640.00 | $54.54 – $365.16 | 63 |
| Radiation treatment aid(s) CPT 77333 | $1,226.50 | $2,453.00 | $126.84 – $497.63 | 63 |
| Radiation treatment aid(s) CPT 77334 | $3,679.50 | $7,359.00 | $170.92 – $1,017.24 | 63 |
| Radiation treatment delivery CPT 77402 | $775.00 | $1,550.00 | $102.66 – $659.86 | 63 |
| Radiation treatment delivery CPT 77412 | $3,679.50 | $7,359.00 | $251.24 – $1,501.13 | 63 |
| Radiology port images(s) CPT 77417 | $175.00 | $350.00 | $28.48 – $61.72 | 6 |
| Radiotherapy dose plan imrt CPT 77301 | $5,117.00 | $10,234.00 | $1,307.18 – $7,009.27 | 63 |
| Radphm lcl tmr plnr bdy sgl day img CPT 78802 | $1,717.50 | $3,435.00 | $274.26 – $1,475.12 | 66 |
| Radphm lcl tmr plnr bdy two day img CPT 78804 | $1,632.50 | $3,265.00 | $546.34 – $2,709.01 | 66 |
| Radphm lcl tmr spect/ct 2+ areas/2+ days CPT 78831 | $1,717.50 | $3,435.00 | $619.62 – $3,517.27 | 63 |
| Radphm lcl tomogr sgl area sgl day CPT 78803 | $1,717.50 | $3,435.00 | $337.43 – $1,517.90 | 66 |
| Radphm lcl tumor plr sgl day CPT 78800 | $1,181.50 | $2,363.00 | $223.78 – $1,086.09 | 62 |
| Radphm quant measure sgl area add-on CPT 78835 | $334.00 | $668.00 | $84.75 – $381.24 | 9 |
| Range of motion measurements CPT 95852 | $73.50 | $147.00 | $4.99 – $95.62 | 56 |
| Rapid Strep Test CPT 87880 | $93.00 | $186.00 | $7.04 – $71.52 | 71 |
| Rbc count only automated CPT 85041 | $69.50 | $139.00 | $1.76 – $13.05 | 71 |
| Rbc osmotic fragility CPT 85555 | $74.50 | $149.00 | $3.92 – $32.30 | 71 |
| Red blood cells frozen/deglycerolized/washed leukocytes reduced irradiated each unit HCPCS P9057 | $461.00 | $922.00 | $422.69 – $1,141.26 | 59 |
| Red blood cells leukocytes reduced each unit HCPCS P9016 | $2,466.00 | $4,932.00 | $182.00 – $499.26 | 59 |
| Red blood cells leukocytes reduced irradiated each unit HCPCS P9040 | $943.00 | $1,886.00 | $255.80 – $716.61 | 59 |
| Red blood cells washed each unit HCPCS P9022 | $341.50 | $683.00 | $368.58 – $995.17 | 59 |
| Regadenoson 0.4 mg/5 ml intravenous syringe HCPCS J2785 | $63.00 | $126.00 | $16.59 – $580.67 | 6 |
| Remdesivir 100 mg intravenous powder for solution HCPCS J0248 | $892.87 | $1,785.75 | $6.35 – $1,242.80 | 62 |
| Remote 30 day ecg tech supp CPT 93229 | $161.50 | $323.00 | $23.93 – $2,577.06 | 63 |
| Removal devitalized tissue non-selective debridement without anesthesia per session CPT 97602 | $358.00 | $716.00 | $115.32 – $545.08 | 60 |
| Remove cva lumen obstruct CPT 75902 | $422.00 | $844.00 | $102.33 – $357.98 | 6 |
| Renal cyst study s&i CPT 74470 | $534.50 | $1,069.00 | $77.28 – $2,262.57 | 66 |
| Renal function panel CPT 80069 | $387.00 | $774.00 | $5.09 – $37.56 | 71 |
| Renal venogram bil s&i CPT 75833 | $1,917.00 | $3,834.00 | $140.93 – $8,578.16 | 66 |
| Reptilase test CPT 85635 | $21.00 | $42.00 | $5.78 – $42.61 | 71 |
| Respirator motion mgmt simul CPT 77293 | $3,867.00 | $7,734.00 | $896.39 – $1,566.44 | 6 |
| #resp virpnl dfa-adenovirus CPT 87260 | $96.50 | $193.00 | $7.04 – $62.44 | 71 |
| Resp virus 6-11 targets CPT 87632 | $422.50 | $845.00 | $123.22 – $943.36 | 71 |
| Resuscitation cardiopulmonary CPT 92950 | $962.00 | $1,924.00 | $217.26 – $586.61 | 60 |
| Reticulated platelet assay CPT 85055 | $108.00 | $216.00 | $15.71 – $154.58 | 71 |
| Reticulocyte automated CPT 85045 | $101.00 | $202.00 | $2.35 – $17.23 | 71 |
| Reticulocyte direct measurement automated CPT 85046 | $47.00 | $94.00 | $3.28 – $24.08 | 71 |
| Revasc intra lithotrip-stent HCPCS C9765 | $10,862.50 | $21,725.00 | $11,232.00 – $49,802.88 | 63 |
| Revasc lithotr-ather tib/per HCPCS C9774 | $18,233.50 | $36,467.00 | $8,618.37 – $49,802.88 | 61 |
| Revasc lithotrip tibi/perone HCPCS C9772 | $11,399.50 | $22,799.00 | $4,750.24 – $31,362.93 | 61 |
| Revasc lithotr-stent tib/per HCPCS C9773 | $18,233.50 | $36,467.00 | $8,497.34 – $49,802.88 | 61 |
| Revasc lith-sten-ath tib/per HCPCS C9775 | $18,233.50 | $36,467.00 | $8,648.20 – $49,802.88 | 61 |
| Revita, per sq cm HCPCS Q4180 | $109.37 | $218.75 | $125.22 – $338.09 | 53 |
| Rheumatoid factor qualitative CPT 86430 | $101.00 | $202.00 | $3.33 – $26.53 | 71 |
| Rheumatoid factor quantitative CPT 86431 | $250.50 | $501.00 | $3.33 – $24.51 | 71 |
| Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe HCPCS J2791 | $6.40 | $12.80 | $7.47 – $23.23 | 6 |
| Rho d immune globulin inj HCPCS J2790 | $307.37 | $614.75 | $124.45 – $180.49 | 6 |
| Right ventric recording CPT 93603 | $2,345.00 | $4,690.00 | $1,159.80 – $3,307.78 | 60 |
| Ropivacaine 0.2 % epidural pca - 1 hour dose limit HCPCS J2795 | $15.00 | $30.00 | $10.76 – $13.13 | 6 |
| Rp loclzj tum 2+area 1+d img CPT 78801 | $816.00 | $1,632.00 | $242.83 – $1,092.35 | 62 |
| Rp loclzj tum spect w/ct 1 CPT 78830 | $1,717.50 | $3,435.00 | $414.24 – $3,517.27 | 63 |
| Rp loclzj tum spect w/ct 2 CPT 78832 | $1,831.50 | $3,663.00 | $782.76 – $3,884.84 | 63 |
| Rsv assay w/optic CPT 87807 | $74.00 | $148.00 | $7.04 – $56.67 | 71 |
| Rubella antibody igg CPT 86762 | $159.50 | $319.00 | $8.45 – $62.22 | 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.