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 |
|---|---|---|---|---|
| Ultrasound pregnant uterus detailed fetal exam single/1st gestation CPT 76811 | $1,023.00 | $2,046.00 | $143.13 – $759.66 | 66 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $363.00 | $726.00 | $99.51 – $447.65 | 66 |
| Ultrasound pregnant uterus limited >= 1 fetuses CPT 76815 | $478.50 | $957.00 | $77.14 – $347.01 | 66 |
| Ultrasound pregnant uterus transvaginal CPT 76817 | $414.50 | $829.00 | $88.25 – $396.97 | 66 |
| Ultrasound prostate/transrectal CPT 76872 | $661.50 | $1,323.00 | $99.51 – $508.74 | 66 |
| Ultrasound retroperitoneal limited CPT 76775 | $549.50 | $1,099.00 | $56.82 – $284.03 | 66 |
| Ultrasound scrotum and contents CPT 76870 | $573.50 | $1,147.00 | $95.23 – $428.38 | 66 |
| Ultrasound spinal canal and contents CPT 76800 | $463.00 | $926.00 | $99.51 – $447.65 | 66 |
| Ultrasound transabd ea addl gest CPT 76812 | $612.00 | $1,224.00 | $182.52 – $821.07 | 9 |
| Ultrasound transvaginal non obstetric CPT 76830 | $661.50 | $1,323.00 | $99.51 – $447.65 | 66 |
| Unlisted maaa CPT 81599 | $146.50 | $293.00 | not published | 0 |
| Unlisted misc path test CPT 89240 | $69.00 | $138.00 | $2.13 – $141.57 | 69 |
| Unlisted procedure microbiology CPT 87999 | $1,485.00 | $2,970.00 | $2.13 – $2.13 | 10 |
| Unlisted surgical path px CPT 88399 | $360.00 | $720.00 | $2.13 – $141.57 | 69 |
| Unsched dialysis esrd pt hos HCPCS G0257 | $3,632.50 | $7,265.00 | $10.71 – $1,864.56 | 60 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $2,998.00 | $5,996.00 | $313.93 – $1,412.18 | 62 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $2,652.50 | $5,305.00 | $267.27 – $1,370.84 | 62 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $2,307.00 | $4,614.00 | $186.33 – $838.20 | 62 |
| Urea nitrogen CPT 84520 | $117.00 | $234.00 | $2.31 – $17.09 | 71 |
| Urea nitrogen 24 hour urine CPT 84540 | $101.00 | $202.00 | $2.79 – $24.08 | 71 |
| Ureteral reflux study CPT 78740 | $475.50 | $951.00 | $193.64 – $1,086.09 | 66 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | $442.50 | $885.00 | $77.31 – $1,076.96 | 66 |
| Urethrocystography void s&i CPT 74455 | $547.50 | $1,095.00 | $99.04 – $648.23 | 66 |
| Uric acid blood CPT 84550 | $108.00 | $216.00 | $2.65 – $19.54 | 71 |
| Uric acid urine CPT 84560 | $61.00 | $122.00 | $2.79 – $21.99 | 71 |
| Urinalysis microscopic only CPT 81015 | $70.00 | $140.00 | $1.78 – $13.19 | 71 |
| Urinalysis (with microscopy) CPT 81001 | $117.00 | $234.00 | $1.86 – $13.70 | 71 |
| Urinalysis (without microscopy) CPT 81003 | $47.00 | $94.00 | $1.32 – $9.73 | 71 |
| Urine Culture Test CPT 87086 | $201.00 | $402.00 | $4.74 – $34.90 | 71 |
| Urine pregnancy test CPT 81025 | $55.50 | $111.00 | $3.71 – $37.28 | 71 |
| Urography, antegrade CPT 74425 | $505.00 | $1,010.00 | $129.19 – $947.81 | 66 |
| Vaccine dtap < 7 years im CPT 90700 | $55.75 | $111.50 | $66.11 – $66.11 | 1 |
| Vaccine dtap-hep b-ipv im CPT 90723 | $175.25 | $350.50 | $221.34 – $221.34 | 1 |
| Vaccine dtap-ipv/hib im CPT 90698 | $206.12 | $412.25 | $268.83 – $268.83 | 1 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | $62.75 | $125.50 | $70.07 – $70.07 | 1 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | $27.75 | $55.50 | $30.33 – $30.33 | 1 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $165.25 | $330.50 | $160.51 – $160.51 | 1 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | $78.25 | $156.50 | $91.32 – $91.32 | 1 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $138.37 | $276.75 | $135.99 – $135.99 | 1 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $61.75 | $123.50 | $54.56 – $54.56 | 1 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | $570.87 | $1,141.75 | $487.37 – $487.37 | 1 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | $159.00 | $318.00 | $105.59 – $105.59 | 1 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | $45.62 | $91.25 | $40.65 – $40.65 | 1 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | $87.50 | $175.00 | $62.88 – $62.88 | 1 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | $466.12 | $932.25 | $477.47 – $477.47 | 1 |
| Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 | $327.37 | $654.75 | $203.34 – $203.34 | 1 |
| Vaccine mmr live subcutaneous CPT 90707 | $178.12 | $356.25 | $167.92 – $167.92 | 1 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | $217.87 | $435.75 | $280.16 – $280.16 | 1 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | $572.75 | $1,145.50 | $592.43 – $592.43 | 1 |
| Vaccine polio (ipv) subcutaneous/im CPT 90713 | $87.50 | $175.00 | $75.79 – $75.79 | 1 |
| Vaccine rabies im CPT 90675 | $775.00 | $1,550.00 | $319.75 – $863.32 | 58 |
| Vaccine respiratory syncytial virus bivalent subunit/preservative free im CPT 90678 | $184.08 | $368.16 | $519.80 – $519.80 | 1 |
| Vaccine rotavirus pentavalent (rv5) live 3 dose oral CPT 90680 | $182.50 | $365.00 | $236.37 – $236.37 | 1 |
| Vaccine tdap >=7 years im CPT 90715 | $89.12 | $178.25 | $94.45 – $94.45 | 1 |
| Vaccine td preservative free >= 7 years im CPT 90714 | $58.87 | $117.75 | $44.31 – $44.31 | 1 |
| Vaccine varicella live subcutaneous CPT 90716 | $356.00 | $712.00 | $379.53 – $379.53 | 1 |
| Valproic acid total therapeutic drug level CPT 80164 | $146.00 | $292.00 | $7.95 – $58.55 | 71 |
| Valvuloplasty aortic CPT 92986 | $9,161.00 | $18,322.00 | $5,447.00 – $15,462.68 | 60 |
| Vancomycin 1,000 mg intravenous injection HCPCS J3373 | $398.12 | $796.25 | $2.30 – $4.78 | 6 |
| Vancomycin 750 mg intravenous solution HCPCS J3374 | $78.75 | $157.50 | $22.95 – $46.61 | 6 |
| Vancomycin peak therapeutic drug level CPT 80202 | $176.00 | $352.00 | $7.95 – $58.55 | 71 |
| Varicella zoster antibody igg CPT 86787 | $68.00 | $136.00 | $7.56 – $55.73 | 71 |
| Veeg cont 2-12 hrs CPT 95713 | $553.50 | $1,107.00 | $90.62 – $1,013.78 | 60 |
| Veeg ea 12-26hr cont mntr CPT 95716 | $963.00 | $1,926.00 | $140.81 – $2,333.00 | 60 |
| Veeg intrmnt 2-12 hrs CPT 95712 | $300.50 | $601.00 | $68.98 – $1,013.78 | 60 |
| Veeg unmon 12-26 hrs CPT 95714 | $553.50 | $1,107.00 | $107.04 – $1,013.78 | 60 |
| Veeg unmon 2-12 hrs CPT 95711 | $300.50 | $601.00 | $217.26 – $599.91 | 60 |
| Vein x-ray adrenal gland CPT 75840 | $1,749.50 | $3,499.00 | $122.21 – $8,578.16 | 66 |
| Vein x-ray eye socket CPT 75880 | $629.50 | $1,259.00 | $102.53 – $1,704.24 | 66 |
| Vein x-ray kidney CPT 75831 | $2,583.50 | $5,167.00 | $113.65 – $8,578.16 | 66 |
| Vein x-ray liver CPT 75891 | $3,083.00 | $6,166.00 | $118.09 – $8,578.16 | 66 |
| Vein x-ray liver w/hemodynam CPT 75885 | $1,895.00 | $3,790.00 | $129.83 – $8,578.16 | 66 |
| Vein x-ray liver w/hemodynam CPT 75889 | $3,468.50 | $6,937.00 | $117.45 – $8,578.16 | 66 |
| Vein x-ray liver without hemodyn CPT 75887 | $1,895.00 | $3,790.00 | $130.78 – $8,578.16 | 66 |
| Vein x-ray skull CPT 75870 | $1,749.50 | $3,499.00 | $147.92 – $8,578.16 | 66 |
| Vein x-ray skull epidural CPT 75872 | $1,746.50 | $3,493.00 | $122.21 – $1,704.24 | 66 |
| Vein x-ray spleen/liver CPT 75810 | $1,749.50 | $3,499.00 | $581.96 – $13,407.79 | 66 |
| Venogram ext bil s&i CPT 75822 | $1,441.50 | $2,883.00 | $126.97 – $4,276.62 | 66 |
| Venogram extremity supervision & interpretation unilateral CPT 75820 | $1,163.00 | $2,326.00 | $102.53 – $4,276.62 | 66 |
| Venous sampling s&i CPT 75893 | $3,738.50 | $7,477.00 | $99.99 – $15,117.44 | 66 |
| Ventilator each subsequent day CPT 94003 | $1,581.50 | $3,163.00 | $167.05 – $1,678.39 | 60 |
| Ventilator initial day CPT 94002 | $1,885.00 | $3,770.00 | $91.31 – $1,678.39 | 60 |
| Very long chain fatty acids CPT 82726 | $97.00 | $194.00 | $10.60 – $85.44 | 71 |
| Virus isolation addl studies ea CPT 87253 | $77.50 | $155.00 | $11.85 – $87.39 | 71 |
| Vital capacity test CPT 94150 | $176.00 | $352.00 | $71.96 – $349.58 | 60 |
| Vitamin b-12 CPT 82607 | $179.00 | $358.00 | $8.85 – $65.25 | 71 |
| Vitamin D Test CPT 82306 | $146.00 | $292.00 | $17.37 – $128.05 | 71 |
| Vkorc1 gene CPT 81355 | $60.00 | $120.00 | $37.04 – $381.55 | 71 |
| Voiding pressure study/intra-abd 51797 CPT 51797 | $587.00 | $1,174.00 | $31.63 – $31.63 | 1 |
| Vol reduction of blood/prod CPT 86960 | $47.50 | $95.00 | $7.32 – $462.86 | 75 |
| Volume measurement urine timed CPT 81050 | $19.00 | $38.00 | $1.76 – $15.72 | 71 |
| Warde 1003990 aldosterone CPT 82088 | $103.00 | $206.00 | $23.91 – $176.28 | 71 |
| Warde 1005020 citrate 24 hour urine CPT 82507 | $20.50 | $41.00 | $16.32 – $120.26 | 71 |
| Warde 1005055 5-hiaa 24 hour urine CPT 83497 | $12.50 | $25.00 | $7.56 – $55.81 | 71 |
| Warde 1006955 catecholamines fractionated 24 hour urine CPT 82384 | $24.00 | $48.00 | $14.82 – $109.23 | 71 |
| Warde 1007138 vanillymandelic acid 24 hour urine CPT 84585 | $10.50 | $21.00 | $9.10 – $67.05 | 71 |
| Warde 1015200 kappa light chain free CPT 83521 | $16.00 | $32.00 | $7.25 – $74.70 | 71 |
| Warde 3004000 immunoglobulin subclass 1 CPT 82787 | $7.50 | $15.00 | $4.70 – $34.68 | 71 |
| Warde 3008005 oligoclonal bands CPT 83916 | $44.00 | $88.00 | $11.80 – $118.46 | 71 |
| Warde 3016000 west nile virus antibody CPT 86788 | $12.50 | $25.00 | $9.89 – $72.89 | 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.