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 |
|---|---|---|---|---|
| Cyp3a4 gene common variants CPT 81230 | $240.00 | $480.00 | $73.42 – $756.26 | 68 |
| Cystatin c CPT 82610 | $55.50 | $111.00 | $7.98 – $80.10 | 71 |
| Cystic fibrosis cftr CPT 81223 | $900.00 | $1,800.00 | $209.58 – $2,158.67 | 71 |
| Cystine urine quantitative CPT 82131 | $12.50 | $25.00 | $9.90 – $99.43 | 71 |
| Cystogram >= 3 views supervision & interpretation CPT 74430 | $536.00 | $1,072.00 | $39.37 – $947.81 | 66 |
| Cystometrogram w/up 51727 CPT 51727 | $774.00 | $1,548.00 | $637.67 – $1,894.40 | 59 |
| Cytogenetics 25-99 CPT 88274 | $78.00 | $156.00 | $20.42 – $183.35 | 71 |
| Cytogenomic neo microra alys CPT 81277 | $1,050.00 | $2,100.00 | $487.20 – $5,018.16 | 68 |
| Cytogenom microarray copy nmbr var CPT 81228 | $971.50 | $1,943.00 | $378.00 – $3,893.40 | 68 |
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $103.00 | $206.00 | $8.45 – $62.22 | 71 |
| Cytomegalovirus (cmv) antibody igm CPT 86645 | $84.50 | $169.00 | $9.89 – $72.89 | 71 |
| Cyto/molecular report CPT 88291 | $346.00 | $692.00 | $11.30 – $145.86 | 71 |
| Cytopath c/v auto in fluid CPT 88174 | $24.50 | $49.00 | $12.54 – $109.74 | 71 |
| Cytopath c/v thin layer redo CPT 88143 | $32.50 | $65.00 | $11.89 – $99.64 | 71 |
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $99.00 | $198.00 | $10.36 – $231.88 | 75 |
| Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review CPT 88175 | $66.00 | $132.00 | $15.54 – $115.14 | 71 |
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | $32.50 | $65.00 | $11.89 – $87.67 | 71 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | $247.50 | $495.00 | $10.36 – $239.87 | 75 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $117.50 | $235.00 | $10.36 – $274.15 | 75 |
| Cytopathology fna adequacy evaluation each separate additional episode same site CPT 88177 | $447.50 | $895.00 | $4.64 – $101.67 | 19 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | $447.50 | $895.00 | $10.36 – $462.86 | 75 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | $406.00 | $812.00 | $10.36 – $587.14 | 75 |
| Cytopath smear oth prep screen & interp CPT 88161 | $124.00 | $248.00 | $10.36 – $287.86 | 75 |
| Cytopath tbs c/v manual CPT 88164 | $9.50 | $19.00 | $6.20 – $68.86 | 71 |
| Cytotoxic antibody screening CPT 86807 | $166.50 | $333.00 | $23.22 – $340.24 | 71 |
| Cytp urine 3-5 probes cmptr CPT 88121 | $345.00 | $690.00 | $23.70 – $1,756.43 | 75 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | $52.50 | $105.00 | $16.07 – $468.44 | 6 |
| Dch pulmonary stress test CPT 94621 | $984.50 | $1,969.00 | $71.96 – $1,013.78 | 60 |
| Dch validity tests CPT 81002 | $43.00 | $86.00 | $1.50 – $15.07 | 71 |
| Deamidated gliadin antibody iga CPT 86258 | $10.50 | $21.00 | $4.84 – $49.89 | 71 |
| Debridement (>20 cm) charge pt CPT 97598 | $483.50 | $967.00 | $17.36 – $6,261.00 | 6 |
| Decalcification CPT 88311 | $292.00 | $584.00 | $4.95 – $69.70 | 19 |
| Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 | $148.50 | $297.00 | $167.05 – $594.91 | 60 |
| Dermapure 1 square cm HCPCS Q4152 | $185.62 | $371.25 | $125.22 – $338.09 | 53 |
| Design mlc device for imrt CPT 77338 | $3,679.50 | $7,359.00 | $349.73 – $1,156.99 | 63 |
| Desmopressin 4 mcg/ml injection solution HCPCS J2597 | $79.87 | $159.75 | $4.95 – $24.15 | 10 |
| Desoxycorticosterone CPT 82633 | $80.00 | $160.00 | $18.18 – $134.03 | 71 |
| Detect agent nos dna dir CPT 87797 | $153.00 | $306.00 | $11.77 – $129.92 | 71 |
| Developmental screen/score/document 96110 CPT 96110 | $411.50 | $823.00 | $22.06 – $297.50 | 5 |
| Devel tst phys/qhp 1st hr CPT 96112 | $432.50 | $865.00 | $91.31 – $149.48 | 5 |
| Device hemospray 7frx220cm endo hemostat min access HCPCS C1052 | $1,521.00 | $3,042.00 | $7.07 – $7.07 | 1 |
| Dev tst admin phys/qhp ea addl 30 min CPT 96113 | $217.00 | $434.00 | $56.13 – $56.13 | 1 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $2.87 | $5.75 | $0.19 – $0.77 | 6 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $16.50 | $33.00 | $13.05 – $96.18 | 71 |
| Diabetes (HbA1c) Test CPT 83036 | $79.00 | $158.00 | $5.70 – $42.03 | 71 |
| Diab manage trn ind/group HCPCS G0109 | $87.50 | $175.00 | $16.03 – $66.15 | 56 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $135.00 | $270.00 | $40.37 – $529.36 | 32 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $74.00 | $148.00 | $40.37 – $415.08 | 32 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $580.00 | $1,160.00 | $156.41 – $529.36 | 59 |
| Diagnostic Mammogram (one breast) CPT 77065 | $469.00 | $938.00 | $123.49 – $415.08 | 59 |
| Dialysis one evaluation CPT 90945 | $3,632.50 | $7,265.00 | $188.63 – $1,133.61 | 62 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $102.87 | $205.75 | $64.53 – $64.53 | 1 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $84.00 | $168.00 | $20.69 – $29.64 | 6 |
| Dicyclomine injection HCPCS J0500 | $51.75 | $103.50 | $17.50 – $67.11 | 6 |
| Diffusing capacity CPT 94729 | $415.50 | $831.00 | $91.31 – $91.31 | 1 |
| Digital analysis of eeg CPT 95957 | $521.50 | $1,043.00 | $145.33 – $145.33 | 1 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $10.25 | $20.50 | $9.08 – $16.92 | 6 |
| Digoxin total therapeutic drug level CPT 80162 | $292.00 | $584.00 | $7.79 – $57.46 | 71 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $2.25 | $4.50 | $1.10 – $1.65 | 6 |
| Disaccharidases CPT 82657 | $499.50 | $999.00 | $10.60 – $95.89 | 71 |
| Discography cerv/thor spine CPT 72285 | $1,718.00 | $3,436.00 | $125.69 – $5,305.11 | 66 |
| Dmpk gene detc abnor allele CPT 81234 | $292.50 | $585.00 | $57.54 – $592.66 | 68 |
| Dna antibody native/double stranded CPT 86225 | $63.50 | $127.00 | $8.06 – $59.41 | 71 |
| Dna gardnerella CPT 87510 | $16.00 | $32.00 | $11.77 – $86.74 | 71 |
| Dna trichomonas CPT 87660 | $16.00 | $32.00 | $11.77 – $86.74 | 71 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $47.25 | $94.50 | $6.81 – $14.18 | 6 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $29.75 | $59.50 | $5.98 – $14.18 | 6 |
| Doppler echo complete CPT 93320 | $690.50 | $1,381.00 | $22.60 – $98.51 | 6 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | $643.00 | $1,286.00 | $651.79 – $651.79 | 1 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $2,459.00 | $4,918.00 | $69.69 – $586.61 | 66 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $654.00 | $1,308.00 | $111.55 – $361.46 | 63 |
| Dpyd gene common variants CPT 81232 | $232.50 | $465.00 | $73.42 – $756.26 | 68 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | $22.37 | $44.75 | $3.99 – $12.69 | 6 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | $11.75 | $23.50 | $3.68 – $338.09 | 54 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | $22.37 | $44.75 | $28.01 – $338.09 | 54 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | $11.75 | $23.50 | $125.22 – $338.09 | 53 |
| Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm HCPCS A2008 | $122.50 | $245.00 | $7.85 – $338.09 | 54 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | $174.00 | $348.00 | $96.13 – $338.09 | 54 |
| Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm HCPCS A2007 | $122.25 | $244.50 | $5.59 – $338.09 | 54 |
| Drug assay caffeine CPT 80155 | $21.50 | $43.00 | $8.11 – $166.84 | 71 |
| Drug assay posaconazole CPT 80187 | $48.00 | $96.00 | $11.39 – $117.31 | 71 |
| Drug assay rufinamide CPT 80210 | $118.00 | $236.00 | $11.39 – $117.31 | 71 |
| Drug assay voriconazole CPT 80285 | $48.50 | $97.00 | $11.39 – $117.31 | 71 |
| Drug of abuse screen urine CPT 80305 | $64.50 | $129.00 | $6.28 – $54.51 | 71 |
| Drug screen quant tiagabine CPT 80199 | $65.50 | $131.00 | $10.34 – $117.31 | 71 |
| Drug test prsmv instrmnt CPT 80306 | $28.50 | $57.00 | $8.38 – $74.12 | 71 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $722.00 | $1,444.00 | $33.52 – $268.79 | 71 |
| Drvvt confirm - quest CPT 85597 | $105.50 | $211.00 | $10.55 – $77.80 | 71 |
| Ductogram sgl duct CPT 77053 | $534.00 | $1,068.00 | $51.42 – $648.23 | 66 |
| Duplex scan bilateral study 93985 CPT 93985 | $1,635.50 | $3,271.00 | $230.93 – $737.81 | 63 |
| Duplex scan unilateral study 93986 CPT 93986 | $1,307.50 | $2,615.00 | $101.59 – $369.50 | 63 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $925.00 | $1,850.00 | $62.08 – $454.44 | 66 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | $307.00 | $614.00 | $107.99 – $668.63 | 66 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $1,587.50 | $3,175.00 | $74.21 – $842.48 | 66 |
| Dura-guard dura repair patch 10x16cm -q4432-cost per sq cm-160sq cm HCPCS Q4432 | $35.71 | $71.43 | $6.04 – $338.09 | 54 |
| Ecg 12 lead tracing only CPT 93005 | $315.50 | $631.00 | $9.99 – $160.27 | 63 |
| Ecg external < 48 hours recording CPT 93225 | $131.00 | $262.00 | $23.93 – $361.46 | 63 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | $1,112.50 | $2,225.00 | $23.93 – $160.27 | 63 |
| Ecg external > 48 hours up to 7 days recording CPT 93242 | $64.50 | $129.00 | $33.91 – $101.47 | 63 |
| Ecg external >7 days up to 15 days recording CPT 93246 | $64.50 | $129.00 | $33.91 – $101.47 | 63 |
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.