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 |
|---|---|---|---|---|
| Contrast x-ray of elbow CPT 73085 | $415.50 | $831.00 | $95.23 – $947.81 | 66 |
| Contrast x-ray of hip CPT 73525 | $416.00 | $832.00 | $122.84 – $947.81 | 66 |
| Contrast x-ray of knee joint CPT 73580 | $526.00 | $1,052.00 | $105.39 – $947.81 | 66 |
| Contrast x-ray of wrist CPT 73115 | $375.50 | $751.00 | $128.56 – $947.81 | 66 |
| Coombs direct CPT 86880 | $135.50 | $271.00 | $3.15 – $160.27 | 75 |
| Coombs indirect titer reference CPT 86886 | $453.50 | $907.00 | $3.04 – $462.86 | 75 |
| Coronary angio/cath placement bypass graft/lv gram/lt heart CPT 93459 | $11,191.50 | $22,383.00 | $3,072.83 – $17,864.00 | 63 |
| Coronary angio/lv gram/lt heart CPT 93458 | $10,693.00 | $21,386.00 | $3,072.83 – $17,864.00 | 63 |
| Coronary angio/lv gram/rt< heart CPT 93460 | $11,402.50 | $22,805.00 | $3,072.83 – $17,864.00 | 63 |
| Coronary art/grft angio s&i CPT 93455 | $8,649.00 | $17,298.00 | $3,072.83 – $17,864.00 | 63 |
| Coronary catheterization w/angiography supervision & interpretation CPT 93454 | $8,149.00 | $16,298.00 | $3,072.83 – $17,864.00 | 63 |
| Cortisol total am CPT 82533 | $156.50 | $313.00 | $9.57 – $70.51 | 71 |
| Cosyntropin 0.25 mg solution for injection HCPCS J0834 | $149.25 | $298.50 | $31.92 – $145.67 | 6 |
| Co-treatment - group 15 mins, st CPT 92508 | $110.50 | $221.00 | $24.17 – $76.36 | 56 |
| Counseling smoke cess interm >10mins CPT 99407 | $38.50 | $77.00 | $6.66 – $101.79 | 60 |
| Covid-19 convalescent plasma HCPCS C9507 | $421.00 | $842.00 | $425.62 – $1,836.08 | 59 |
| Covid-19 IV infusion and post admin monitoring tocilizumab 1st dose HCPCS M0249 | $414.00 | $828.00 | $430.39 – $1,197.96 | 59 |
| Covid-19 IV infusion and post admin monitoring tocilizumab 2nd dose HCPCS M0250 | $414.00 | $828.00 | $430.39 – $1,197.96 | 59 |
| #covid19rsv-rsv CPT 87634 | $34.00 | $68.00 | $36.40 – $303.69 | 71 |
| #coxa-coxsackie a serotype a16 CPT 86658 | $29.00 | $58.00 | $7.64 – $56.38 | 71 |
| C-peptide CPT 84681 | $71.00 | $142.00 | $12.21 – $90.05 | 71 |
| Crbrospnl fld flw imag cistern CPT 78630 | $878.00 | $1,756.00 | $298.39 – $1,475.12 | 66 |
| C-reactive protein CPT 86140 | $247.50 | $495.00 | $3.04 – $22.42 | 71 |
| C-reactive protein high sensitivity CPT 86141 | $18.00 | $36.00 | $7.60 – $56.02 | 71 |
| C-reactive protein, quantitative CPT 86406 | $53.50 | $107.00 | $6.25 – $46.00 | 71 |
| Creatine kinase CPT 82550 | $176.00 | $352.00 | $3.82 – $28.19 | 71 |
| Creatine kinase isoenzymes CPT 82552 | $9.50 | $19.00 | $7.86 – $57.90 | 71 |
| Creatine kinase mb CPT 82553 | $151.00 | $302.00 | $6.77 – $49.97 | 71 |
| Creatinine CPT 82565 | $117.00 | $234.00 | $3.01 – $22.13 | 71 |
| Creatinine 24 hour urine CPT 82570 | $117.00 | $234.00 | $3.04 – $22.42 | 71 |
| Creatinine clearance urine CPT 82575 | $211.50 | $423.00 | $5.54 – $40.95 | 71 |
| #creutz-prot.,western blot CPT 84182 | $110.00 | $220.00 | $10.56 – $126.39 | 71 |
| Critical care 30-74 minutes CPT 99291 | $2,327.00 | $4,654.00 | $805.00 – $2,244.13 | 59 |
| Crotalidae poly immune fab HCPCS J0840 | $4,029.50 | $8,059.00 | $1,779.64 – $7,643.22 | 62 |
| Cryofibrinogen qualitative - sendout CPT 82585 | $27.50 | $55.00 | $5.03 – $61.14 | 71 |
| Cryoprecipitate each unit HCPCS P9012 | $442.00 | $884.00 | $63.57 – $194.27 | 59 |
| Crystal identification light microscopy CPT 89060 | $60.00 | $120.00 | $4.20 – $31.72 | 71 |
| Csf leakage imaging CPT 78650 | $850.00 | $1,700.00 | $239.97 – $3,517.27 | 66 |
| Csf ventriculography CPT 78635 | $877.00 | $1,754.00 | $299.01 – $1,475.12 | 66 |
| CT 3d report other modality w/workstation CPT 76377 | $1,908.50 | $3,817.00 | $53.59 – $53.59 | 1 |
| Cta abdomen without & /or w/contrast CPT 74175 | $3,111.50 | $6,223.00 | $166.31 – $748.12 | 62 |
| Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast CPT 75635 | $2,431.00 | $4,862.00 | $166.31 – $748.12 | 62 |
| Cta lower extremity without & w/contrast (both sides) CPT 73706 | $3,210.00 | $6,420.00 | $166.31 – $748.12 | 62 |
| Cta neck without &/or w/contrast CPT 70498 | $2,883.00 | $5,766.00 | $166.31 – $748.12 | 62 |
| CT Angiogram of Abdomen and Pelvis CPT 74174 | $4,607.50 | $9,215.00 | $341.19 – $1,565.90 | 62 |
| CT Angiogram of the Chest (for blood clot) CPT 71275 | $2,835.50 | $5,671.00 | $166.31 – $748.12 | 62 |
| CT Angiogram of the Head CPT 70496 | $2,824.50 | $5,649.00 | $166.31 – $748.12 | 62 |
| CT angio hrt w/3d image CPT 75574 | $1,130.00 | $2,260.00 | $166.31 – $947.81 | 62 |
| CT angio pelvis CPT 72191 | $2,808.50 | $5,617.00 | $166.31 – $748.12 | 62 |
| Cta upper extremity w &/or without contrast left CPT 73206 | $3,730.50 | $7,461.00 | $166.31 – $748.12 | 62 |
| CT cerebral perf w cont & prcssng CPT 70473 | $1,783.00 | $3,566.00 | $176.49 – $643.33 | 55 |
| CT guidance for needle placement CPT 77012 | $1,664.50 | $3,329.00 | $132.16 – $132.16 | 1 |
| CT guidance for percutaneous drain w/catheter placement supervision & interpretation CPT 75989 | $869.50 | $1,739.00 | $107.81 – $107.81 | 1 |
| CT guid parench tis ablat CPT 77013 | $1,783.50 | $3,567.00 | $332.54 – $332.54 | 1 |
| CT heart w/evaluation of calcium without contrast CPT 75571 | $129.00 | $258.00 | $82.25 – $370.00 | 62 |
| CT hrt c+ strux cgen hrt ds CPT 75573 | $1,130.00 | $2,260.00 | $166.31 – $947.81 | 62 |
| CT hrt w/3d image CPT 75572 | $1,130.00 | $2,260.00 | $166.31 – $947.81 | 62 |
| CT limited or localized follow-up study CPT 76380 | $1,422.50 | $2,845.00 | $82.25 – $370.00 | 62 |
| CT lower extremity w/contrast (both sides) CPT 73701 | $2,092.50 | $4,185.00 | $162.84 – $732.52 | 62 |
| CT lower extremity without contrast (both sides) CPT 73700 | $1,819.50 | $3,639.00 | $99.51 – $447.65 | 62 |
| CT lwr extremity w/o&w/dye CPT 73702 | $2,365.00 | $4,730.00 | $166.31 – $748.12 | 62 |
| CT neck soft tissue w/contrast CPT 70491 | $2,257.00 | $4,514.00 | $166.31 – $748.12 | 62 |
| CT neck soft tissue without contrast CPT 70490 | $1,962.50 | $3,925.00 | $99.51 – $447.65 | 62 |
| CT neck soft tissue without & w/contrast CPT 70492 | $2,552.00 | $5,104.00 | $166.31 – $748.12 | 62 |
| CT orbit/sella/fossa w/wo contrast CPT 70482 | $2,316.50 | $4,633.00 | $166.31 – $748.12 | 62 |
| CT orbit/sella/ or posterior outer inner or middle ear w/contrast CPT 70481 | $2,049.50 | $4,099.00 | $166.31 – $748.12 | 62 |
| CT orbit/sella/ or posterior outer inner or middle ear without contrast CPT 70480 | $1,782.00 | $3,564.00 | $99.51 – $447.65 | 62 |
| CT Scan of Abdomen and Pelvis (with and without contrast) CPT 74178 | $5,006.00 | $10,012.00 | $332.67 – $1,496.49 | 62 |
| CT Scan of Abdomen and Pelvis (with contrast) CPT 74177 | $4,335.00 | $8,670.00 | $296.48 – $1,370.84 | 62 |
| CT Scan of Abdomen and Pelvis (without contrast) CPT 74176 | $3,769.50 | $7,539.00 | $178.70 – $836.61 | 62 |
| CT thoracic spine w/contrast CPT 72129 | $2,577.00 | $5,154.00 | $166.01 – $746.79 | 62 |
| CT thoracic spine without contrast CPT 72128 | $2,240.50 | $4,481.00 | $99.51 – $447.65 | 62 |
| CT thorax low dose for lung screening without contrast CPT 71271 | $170.50 | $341.00 | $99.51 – $447.65 | 62 |
| CT t-spine w /wo contrast CPT 72130 | $2,912.50 | $5,825.00 | $166.31 – $748.12 | 62 |
| CT upper extremity w/contrast (both sides) CPT 73201 | $1,925.50 | $3,851.00 | $196.17 – $1,370.84 | 62 |
| CT upper extremity without contrast (both sides) CPT 73200 | $1,675.00 | $3,350.00 | $99.51 – $447.65 | 62 |
| CT uppr extremity w/o&w/dye CPT 73202 | $2,177.00 | $4,354.00 | $166.31 – $748.12 | 62 |
| Culture aerobic additional method definitive id each CPT 87077 | $188.00 | $376.00 | $4.74 – $34.97 | 71 |
| Culture afb any source CPT 87116 | $33.50 | $67.00 | $6.34 – $46.72 | 71 |
| Culture anaerobic additional method definitive id each CPT 87076 | $188.00 | $376.00 | $4.74 – $34.97 | 71 |
| Culture anaerobic except blood CPT 87075 | $333.50 | $667.00 | $5.55 – $40.95 | 71 |
| Culture bact stool aero addl path ea CPT 87046 | $101.00 | $202.00 | $5.54 – $40.81 | 71 |
| Culture body fluid CPT 87070 | $195.50 | $391.00 | $5.05 – $37.28 | 71 |
| Culture fungi definitive id mold CPT 87107 | $195.50 | $391.00 | $6.06 – $44.63 | 71 |
| Culture fungi definitive id yeast CPT 87106 | $188.00 | $376.00 | $6.06 – $44.63 | 71 |
| Culture fungi other (except blood) CPT 87102 | $186.00 | $372.00 | $4.93 – $36.41 | 71 |
| Culture fungi skin/hair/nail CPT 87101 | $186.00 | $372.00 | $4.52 – $33.38 | 71 |
| Culture mycoplasma any source CPT 87109 | $18.00 | $36.00 | $9.03 – $66.55 | 71 |
| Culture quantitative aerobic other source CPT 87071 | $201.00 | $402.00 | $5.54 – $42.76 | 71 |
| Culture screening strep group a CPT 87081 | $101.00 | $202.00 | $3.89 – $28.70 | 71 |
| Culture typing added method CPT 87158 | $54.00 | $108.00 | $3.07 – $33.45 | 71 |
| Culture typing immunologic CPT 87147 | $195.50 | $391.00 | $3.04 – $22.42 | 71 |
| Culture typing nucleic acid probe amplified per culture/isolate each organism CPT 87150 | $165.00 | $330.00 | $21.11 – $151.77 | 71 |
| Culture urine each isolate CPT 87088 | $43.00 | $86.00 | $4.75 – $34.97 | 71 |
| Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 | $13.12 | $26.25 | $0.98 – $8.25 | 6 |
| Cyclic citrullinated peptide antibody CPT 86200 | $12.00 | $24.00 | $7.60 – $56.02 | 71 |
| Cyclosporine 2 hour CPT 80158 | $711.00 | $1,422.00 | $10.60 – $78.08 | 71 |
| Cygnus matrix, per sq cm HCPCS Q4199 | $60.94 | $121.88 | $6.04 – $338.09 | 54 |
| Cyp2c19 gene com variants CPT 81225 | $169.00 | $338.00 | $122.56 – $1,260.45 | 71 |
| Cyp2c9 gene com variants CPT 81227 | $60.00 | $120.00 | $73.53 – $756.26 | 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.