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 |
|---|---|---|---|---|
| Rubeola antibody igg CPT 86765 | $63.50 | $127.00 | $7.56 – $55.73 | 71 |
| Russell viper venom diluted CPT 85613 | $29.50 | $59.00 | $5.62 – $41.46 | 71 |
| Salivary gland function exam CPT 78232 | $780.00 | $1,560.00 | $96.81 – $1,086.09 | 66 |
| Salmonella antibody CPT 86768 | $8.00 | $16.00 | $7.74 – $57.03 | 71 |
| Sars-cov-2 antb quantitative CPT 86413 | $185.00 | $370.00 | $17.73 – $303.76 | 71 |
| Sarscov coronavirus ag ia CPT 87426 | $61.50 | $123.00 | $19.05 – $326.11 | 71 |
| Sarscov & inf vir a&b ag ia CPT 87428 | $95.00 | $190.00 | $30.92 – $529.86 | 71 |
| Scan duplex abd/pelvis/retroperitoneal complete CPT 93975 | $2,256.50 | $4,513.00 | $36.39 – $1,032.99 | 66 |
| Scan duplex abd/pelvis/retroperitoneal limited CPT 93976 | $1,509.00 | $3,018.00 | $73.97 – $454.44 | 66 |
| Scan duplex aorta/ivc/iliac or bypass grafts complete CPT 93978 | $591.00 | $1,182.00 | $15.17 – $768.20 | 66 |
| Scan duplex aorta/ivc/iliac unilateral/limited CPT 93979 | $1,074.50 | $2,149.00 | $101.02 – $454.44 | 66 |
| Scan duplex extracranial arteries unilateral/limited study CPT 93882 | $851.50 | $1,703.00 | $15.17 – $454.44 | 66 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $1,147.00 | $2,294.00 | $42.10 – $454.44 | 66 |
| Scan duplex lower extremity arteries complete bilateral CPT 93925 | $1,809.00 | $3,618.00 | $66.13 – $1,010.94 | 66 |
| Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 | $1,035.00 | $2,070.00 | $101.02 – $454.44 | 66 |
| Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 | $1,061.00 | $2,122.00 | $100.38 – $454.44 | 66 |
| Scope uretscp lithovue dig disp HCPCS C1747 | $2,996.25 | $5,992.50 | $11.94 – $179.62 | 5 |
| Screening Mammogram CPT 77067 | $381.00 | $762.00 | $125.84 – $339.77 | 56 |
| Serpina1 gene CPT 81332 | $154.00 | $308.00 | $25.01 – $188.83 | 71 |
| Sertraline (zoloft) - sendout CPT 80332 | $97.50 | $195.00 | $0.06 – $183.09 | 44 |
| Set radiation therapy field CPT 77280 | $3,679.50 | $7,359.00 | $126.84 – $1,156.56 | 63 |
| Set radiation therapy field CPT 77290 | $3,679.50 | $7,359.00 | $349.73 – $1,882.31 | 63 |
| Shoulder MRI (with and without contrast) CPT 73223 | $3,110.00 | $6,220.00 | $341.19 – $1,565.90 | 62 |
| Shoulder MRI (with contrast) CPT 73222 | $2,751.50 | $5,503.00 | $306.95 – $2,444.14 | 62 |
| Shoulder MRI (without contrast) CPT 73221 | $2,392.00 | $4,784.00 | $198.70 – $893.85 | 62 |
| Shoulder X-ray CPT 73030 | $339.50 | $679.00 | $33.34 – $236.43 | 66 |
| Shuntogram nonvascular supervision & interpretation CPT 75809 | $235.00 | $470.00 | $77.77 – $349.83 | 66 |
| Sialography s&i CPT 70390 | $300.50 | $601.00 | $110.14 – $648.23 | 66 |
| Sickling rbc CPT 85660 | $74.00 | $148.00 | $3.24 – $23.87 | 71 |
| Sincalide 5 mcg solution for injection HCPCS J2805 | $242.75 | $485.50 | $170.18 – $241.80 | 6 |
| Sinus CT scan (with and without contrast) CPT 70488 | $2,208.00 | $4,416.00 | $166.31 – $748.12 | 62 |
| Sinus CT scan (with contrast) CPT 70487 | $1,952.50 | $3,905.00 | $148.56 – $668.29 | 62 |
| Sinus CT scan (without contrast) CPT 70486 | $1,698.50 | $3,397.00 | $99.51 – $447.65 | 62 |
| Sinus/juglr venogram s&i CPT 75860 | $1,810.50 | $3,621.00 | $119.36 – $8,578.16 | 66 |
| Sirolimus, oral HCPCS J7520 | $13.50 | $27.00 | $1.50 – $21.68 | 6 |
| Skeletal muscle relaxant 1/2 CPT 80369 | $133.50 | $267.00 | $0.06 – $183.09 | 44 |
| Sleep Study (Polysomnography) CPT 95810 | $3,734.50 | $7,469.00 | $248.09 – $2,333.00 | 63 |
| Sleep study unattended CPT 95806 | $359.00 | $718.00 | $135.16 – $586.61 | 63 |
| Sleeve fing rolyan med HCPCS L3933 | $206.00 | $412.00 | $239.91 – $647.76 | 53 |
| Small animal inoculation CPT 87003 | $16.00 | $32.00 | $9.88 – $72.82 | 71 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $29.50 | $59.00 | $3.15 – $23.29 | 71 |
| Smear gram stain CPT 87205 | $70.50 | $141.00 | $2.50 – $18.46 | 71 |
| Smear nasal eosinophil CPT 89190 | $69.00 | $138.00 | $2.79 – $25.02 | 71 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $115.50 | $231.00 | $3.52 – $25.88 | 71 |
| Smear wet mount CPT 87210 | $70.50 | $141.00 | $2.50 – $25.16 | 71 |
| Smpd1 gene common variants CPT 81330 | $43.00 | $86.00 | $19.74 – $203.32 | 71 |
| Snrpn/ube3a gene CPT 81331 | $251.50 | $503.00 | $21.45 – $220.91 | 71 |
| Sodium 24 hour urine CPT 84300 | $134.00 | $268.00 | $2.85 – $21.92 | 71 |
| Sodium serum/plasma/whole blood CPT 84295 | $134.50 | $269.00 | $2.82 – $20.84 | 71 |
| So gsap cll fr mcrstl ins CPT 81464 | $1,751.50 | $3,503.00 | $477.13 – $14,226.12 | 62 |
| Somatosensory testing CPT 95927 | $1,439.50 | $2,879.00 | $35.68 – $586.61 | 60 |
| Special physics consult CPT 77370 | $812.50 | $1,625.00 | $126.84 – $644.36 | 63 |
| Special radiation dosimetry CPT 77331 | $346.50 | $693.00 | $48.07 – $365.16 | 63 |
| Special radiation treatment CPT 77470 | $2,966.00 | $5,932.00 | $64.10 – $1,501.13 | 63 |
| Special teletx port plan CPT 77321 | $1,166.00 | $2,332.00 | $110.38 – $1,017.24 | 63 |
| Specimen fat stain CPT 89125 | $11.50 | $23.00 | $2.53 – $25.45 | 71 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $629.50 | $1,259.00 | $91.31 – $1,013.78 | 60 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $381.50 | $763.00 | $444.32 – $1,199.66 | 52 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | $73.00 | $146.00 | $60.42 – $163.13 | 53 |
| Splint finger frog med HCPCS L3927 | $77.00 | $154.00 | $39.34 – $106.22 | 53 |
| Splint rstrc wrst/cmc right med HCPCS L3923 | $71.00 | $142.00 | $97.81 – $264.09 | 53 |
| Split blood or products CPT 86985 | $63.00 | $126.00 | $22.46 – $462.86 | 72 |
| Srs linear based CPT 77372 | $11,659.00 | $23,318.00 | $2,691.86 – $20,009.82 | 63 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $433.00 | $866.00 | $2.85 – $297.97 | 56 |
| Staph a dna amp probe CPT 87640 | $97.00 | $194.00 | $20.60 – $151.77 | 71 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $425.00 | $850.00 | $55.42 – $279.53 | 56 |
| St evaluate speech sound production CPT 92522 | $433.00 | $866.00 | $9.52 – $304.16 | 56 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $433.00 | $866.00 | $5.71 – $616.44 | 56 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $433.00 | $866.00 | $67.55 – $247.02 | 56 |
| St evaluation swallow function CPT 92610 | $324.00 | $648.00 | $22.36 – $156.79 | 56 |
| Stimulants synthetic CPT 80371 | $117.00 | $234.00 | $0.06 – $183.09 | 44 |
| Strep a ag ia CPT 87430 | $231.00 | $462.00 | $7.04 – $72.75 | 71 |
| Strep b dna amp probe CPT 87653 | $74.50 | $149.00 | $20.60 – $151.77 | 71 |
| Stress test pulmonary CPT 94618 | $166.00 | $332.00 | $121.41 – $361.46 | 60 |
| Stress tte complete CPT 93351 | $3,013.50 | $6,027.00 | $107.99 – $1,484.49 | 63 |
| Str markers spec anal addl CPT 81266 | $292.00 | $584.00 | $128.02 – $1,318.64 | 71 |
| Str markers specimen anal CPT 81265 | $535.00 | $1,070.00 | $123.22 – $1,008.25 | 71 |
| St treatment speech individual CPT 92507 | $216.50 | $433.00 | $71.96 – $207.23 | 56 |
| St treatment swallow dysfunction/oral CPT 92526 | $216.50 | $433.00 | $6.18 – $228.93 | 56 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $20.25 | $40.50 | $6.58 – $15.89 | 6 |
| Sugars single quant CPT 84378 | $48.50 | $97.00 | $6.76 – $49.89 | 71 |
| Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution HCPCS J2865 | $7.00 | $14.00 | $0.06 – $0.14 | 6 |
| Sulfonylurea screen qn-sendout CPT 80377 | $96.00 | $192.00 | $0.06 – $183.09 | 44 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $23.12 | $46.25 | $57.81 – $105.42 | 6 |
| Surgical pathology level 1 gross examination only CPT 88300 | $94.50 | $189.00 | $4.95 – $78.58 | 75 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $124.00 | $248.00 | $4.95 – $114.23 | 75 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $154.50 | $309.00 | $10.36 – $146.24 | 75 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $185.00 | $370.00 | $10.36 – $245.60 | 75 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $214.50 | $429.00 | $14.62 – $982.39 | 75 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $244.00 | $488.00 | $14.62 – $2,188.85 | 75 |
| Susceptibility agar dilution per agent CPT 87181 | $188.00 | $376.00 | $2.79 – $20.55 | 71 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $188.00 | $376.00 | $2.79 – $20.55 | 71 |
| Susceptibility mic per plate CPT 87186 | $188.00 | $376.00 | $5.07 – $37.42 | 71 |
| Suscept studies macrobroth dilution ea CPT 87188 | $35.50 | $71.00 | $3.89 – $28.70 | 71 |
| Svc venogram s&i CPT 75827 | $1,749.50 | $3,499.00 | $113.00 – $4,276.62 | 66 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $97.00 | $194.00 | $2.59 – $19.03 | 71 |
| System recell skin grafting/harvesting HCPCS C1832 | $4,640.62 | $9,281.25 | $1.88 – $1.88 | 1 |
| System sealant biosentry tract HCPCS C2613 | $300.00 | $600.00 | $252.02 – $252.02 | 1 |
| T3 (triiodothyronine) free CPT 84481 | $188.00 | $376.00 | $9.94 – $73.25 | 71 |
| T3 (triiodothyronine) total CPT 84480 | $208.00 | $416.00 | $8.32 – $61.36 | 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.