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 |
|---|---|---|---|---|
| T4 (thyroxine) free CPT 84439 | $188.00 | $376.00 | $5.29 – $39.01 | 71 |
| T4 (thyroxine) total CPT 84436 | $208.00 | $416.00 | $4.04 – $29.71 | 71 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $7.00 | $14.00 | $0.31 – $8.68 | 6 |
| Tacrolimus therapeutic drug level CPT 80197 | $479.00 | $958.00 | $8.05 – $59.41 | 71 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $1,496.50 | $2,993.00 | $1,226.23 – $12,630.19 | 71 |
| Target gsa panel organ neop CPT 81445 | $1,376.50 | $2,753.00 | $251.12 – $2,586.59 | 68 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $464.75 | $929.50 | $0.25 – $587.94 | 62 |
| Tbs techl calculation only CPT 77091 | $89.50 | $179.00 | $84.12 – $236.43 | 63 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $45.00 | $90.00 | $36.63 – $432.60 | 71 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $139.00 | $278.00 | $36.37 – $268.14 | 71 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $249.75 | $499.50 | $325.35 – $325.35 | 1 |
| Tc-99m tilmanocept diag HCPCS A9520 | $1,257.12 | $2,514.25 | $971.72 – $1,118.33 | 6 |
| Tcd emboli detect w/inj CPT 93893 | $122.00 | $244.00 | $71.96 – $454.44 | 66 |
| Tcd emboli detect without inj CPT 93892 | $122.00 | $244.00 | $101.02 – $454.44 | 66 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $75.00 | $150.00 | $27.57 – $203.25 | 71 |
| T cells absolute cd 4 count CPT 86361 | $26.50 | $53.00 | $15.71 – $115.86 | 71 |
| T cells total count CPT 86359 | $45.00 | $90.00 | $22.13 – $163.23 | 71 |
| Telethx isodose plan cplx CPT 77307 | $2,335.50 | $4,671.00 | $347.16 – $1,017.24 | 63 |
| Telethx isodose plan simple CPT 77306 | $1,606.50 | $3,213.00 | $192.26 – $1,017.24 | 63 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $10,454.62 | $20,909.25 | $162.43 – $8,261.75 | 62 |
| Tert gene targeted seq alys CPT 81345 | $186.00 | $372.00 | $77.78 – $801.18 | 71 |
| Test for urine cystines CPT 82615 | $17.00 | $34.00 | $4.79 – $41.31 | 71 |
| Testicular imaging w/vasc flow CPT 78761 | $837.50 | $1,675.00 | $190.14 – $1,086.09 | 66 |
| Test pathogen(s) for platelets reference HCPCS P9100 | $45.00 | $90.00 | $10.71 – $160.27 | 69 |
| Test stress cardiovascular tracing only CPT 93017 | $1,439.00 | $2,878.00 | $36.31 – $586.61 | 63 |
| Theophylline therapeutic drug level CPT 80198 | $9.50 | $19.00 | $8.30 – $61.14 | 71 |
| Therapeutic procd strg endur HCPCS G0237 | $124.00 | $248.00 | $23.40 – $78.58 | 60 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | $58.50 | $117.00 | $22.36 – $71.47 | 56 |
| Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes CPT 97803 | $58.50 | $117.00 | $18.79 – $59.70 | 56 |
| Ther nma rdctj intus/obstrcj CPT 74283 | $981.50 | $1,963.00 | $166.31 – $769.02 | 66 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $21.00 | $42.00 | $5.57 – $14.67 | 6 |
| Thrombectmy crnry perq mechanical CPT 92973 | $5,346.00 | $10,692.00 | $36.31 – $36.31 | 1 |
| Thrombin time CPT 85670 | $104.50 | $209.00 | $3.39 – $24.95 | 71 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $37.50 | $75.00 | $3.80 – $27.97 | 71 |
| Thyroglobulin antibody CPT 86800 | $14.00 | $28.00 | $9.33 – $68.86 | 71 |
| Thyroid imaging CPT 78013 | $816.00 | $1,632.00 | $163.15 – $1,086.09 | 66 |
| Thyroid mets imag whole body CPT 78018 | $816.00 | $1,632.00 | $276.17 – $1,475.12 | 66 |
| Thyroid (TSH) Test CPT 84443 | $345.00 | $690.00 | $9.86 – $72.68 | 71 |
| Thyroid Ultrasound CPT 76536 | $497.00 | $994.00 | $99.51 – $447.65 | 66 |
| Thyroid uptake measurement CPT 78012 | $816.00 | $1,632.00 | $77.14 – $1,086.09 | 66 |
| Thyrotropin releasing hormone CPT 80438 | $36.00 | $72.00 | $29.57 – $218.10 | 71 |
| Thyroxine binding globulin (tbg) CPT 84442 | $12.50 | $25.00 | $8.68 – $63.95 | 71 |
| Tilt table study CPT 93660 | $2,001.50 | $4,003.00 | $22.36 – $1,013.78 | 60 |
| Tirofiban 12.5 mg/50 ml HCPCS J3246 | $171.12 | $342.25 | $106.49 – $495.21 | 6 |
| Tissue culture skin/biopsy CPT 88233 | $169.00 | $338.00 | $82.58 – $608.81 | 71 |
| Tissue culture tumor CPT 88239 | $288.50 | $577.00 | $86.57 – $638.16 | 71 |
| Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm HCPCS Q4122 | $89.58 | $179.17 | $125.22 – $338.09 | 53 |
| Tissue transglutaminase iga CPT 86364 | $16.00 | $32.00 | $4.84 – $49.89 | 71 |
| Tixagev and cilgav inj HCPCS M0220 | $138.50 | $277.00 | $143.78 – $143.78 | 4 |
| Tlso r fram soft pre ots HCPCS L0467 | $215.39 | $430.79 | $284.88 – $769.18 | 53 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | $139.50 | $279.00 | $1.08 – $3.66 | 6 |
| Tobramycin peak therapeutic drug level CPT 80200 | $47.00 | $94.00 | $9.46 – $69.79 | 71 |
| Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 | $3,346.37 | $6,692.75 | $5.61 – $2,471.26 | 62 |
| Tomosynthesis breast screen bilateral CPT 77063 | $135.00 | $270.00 | $42.64 – $225.60 | 59 |
| Total tau CPT 84394 | $347.50 | $695.00 | $27.29 – $1,081.75 | 59 |
| Toxoplasma antibody igg CPT 86777 | $150.00 | $300.00 | $8.45 – $62.22 | 71 |
| Toxoplasma antibody igm CPT 86778 | $72.00 | $144.00 | $8.45 – $62.37 | 71 |
| Tp53 gene full gene sequence CPT 81351 | $1,050.00 | $2,100.00 | $269.58 – $2,776.64 | 71 |
| Tp53 gene trgt sequence alys CPT 81352 | $485.00 | $970.00 | $138.39 – $1,425.49 | 71 |
| Tpmt gene com vrnts CPT 81335 | $296.50 | $593.00 | $73.42 – $756.26 | 68 |
| Training self management diabetes individual outpatient department per 30 minutes HCPCS G0108 | $148.50 | $297.00 | $18.04 – $150.55 | 56 |
| Transcath closure of asd CPT 93580 | $15,698.00 | $31,396.00 | $8,669.00 – $49,802.88 | 63 |
| Transcath closure of vsd CPT 93581 | $16,520.00 | $33,040.00 | $8,669.00 – $49,802.88 | 63 |
| Transcatheter bx s&i CPT 75970 | $1,377.50 | $2,755.00 | $68.82 – $1,739.27 | 6 |
| Transcutaneous hgb 88738 CPT 88738 | $12.50 | $25.00 | $3.02 – $21.70 | 68 |
| Transferrin CPT 84466 | $211.00 | $422.00 | $7.49 – $55.23 | 71 |
| Transfusion blood/blood component(s) CPT 36430 | $1,275.00 | $2,550.00 | $417.66 – $1,198.57 | 59 |
| Trauma partial team response w/critical care services level 4 HCPCS G0390 | $10,995.50 | $21,991.00 | $5.71 – $3,621.21 | 60 |
| Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour CPT 94644 | $250.50 | $501.00 | $71.96 – $361.46 | 60 |
| Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour CPT 94645 | $250.50 | $501.00 | $121.41 – $121.41 | 1 |
| Treatment inhalation pressurized/nonpressurized acute airway obstruction CPT 94640 | $151.00 | $302.00 | $121.41 – $594.91 | 60 |
| Treatment radiation delivery level 2 CPT 77407 | $1,052.50 | $2,105.00 | $251.24 – $1,047.85 | 63 |
| Treponema pallidum antibody CPT 86780 | $180.00 | $360.00 | $7.97 – $57.25 | 71 |
| Trg gene rearrangement anal CPT 81342 | $281.50 | $563.00 | $115.46 – $871.69 | 71 |
| Triamcinolone acetonide 40 mg/ml suspension for injection HCPCS J3301 | $17.87 | $35.75 | $4.59 – $12.14 | 6 |
| Trichinella antibody CPT 86784 | $33.50 | $67.00 | $7.37 – $54.36 | 71 |
| #tricyclicantidprssnt CPT 80337 | $63.00 | $126.00 | $0.06 – $183.09 | 44 |
| Triglycerides CPT 84478 | $239.00 | $478.00 | $3.38 – $24.80 | 71 |
| Troponin quantitative CPT 84484 | $222.00 | $444.00 | $5.78 – $53.93 | 71 |
| Tx atrial fib pulm vein isol CPT 93656 | $27,791.00 | $55,582.00 | $12,413.00 – $71,010.61 | 63 |
| Tx l/r atrial fib addl CPT 93657 | $1,384.50 | $2,769.00 | $84.92 – $6,261.00 | 6 |
| Ugt1a1 gene analy common variants CPT 81350 | $658.00 | $1,316.00 | $98.28 – $1,012.28 | 71 |
| Ultrasound abdomen aorta screening study aaa CPT 76706 | $506.50 | $1,013.00 | $99.51 – $447.65 | 66 |
| Ultrasound breast complete CPT 76641 | $499.50 | $999.00 | $97.76 – $439.79 | 66 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $288.50 | $577.00 | $80.94 – $364.10 | 66 |
| Ultrasound chest CPT 76604 | $188.00 | $376.00 | $54.28 – $284.03 | 66 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | $357.00 | $714.00 | $42.54 – $284.03 | 66 |
| Ultrasound dx ophth b-scan CPT 76512 | $145.50 | $291.00 | $45.70 – $284.03 | 66 |
| Ultrasound elastography ea l target les CPT 76983 | $310.50 | $621.00 | $57.87 – $264.15 | 9 |
| Ultrasound elastography parenchyma CPT 76981 | $387.00 | $774.00 | $99.36 – $446.97 | 66 |
| Ultrasound encephalogram CPT 76506 | $715.50 | $1,431.00 | $99.51 – $447.65 | 66 |
| Ultrasound exam k transpl w/doppler CPT 76776 | $595.50 | $1,191.00 | $99.51 – $541.33 | 66 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $426.50 | $853.00 | $81.59 – $367.01 | 66 |
| Ultrasound guided needle placement supervision & interpretation CPT 76942 | $818.50 | $1,637.00 | $42.64 – $129.42 | 6 |
| Ultrasound guide intraoperative CPT 76998 | $1,155.00 | $2,310.00 | $110.24 – $271.10 | 6 |
| Ultrasound hips infant dynamic CPT 76885 | $406.00 | $812.00 | $82.25 – $377.88 | 66 |
| Ultrasound infant hips ltd without stress CPT 76886 | $364.00 | $728.00 | $82.25 – $370.00 | 66 |
| Ultrasound joint/nonvascular extremity limited left CPT 76882 | $506.50 | $1,013.00 | $28.83 – $284.03 | 66 |
| Ultrasound ob >=14wks ea addl gest CPT 76810 | $567.00 | $1,134.00 | $73.09 – $374.10 | 9 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | $531.50 | $1,063.00 | $37.15 – $257.01 | 9 |
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.