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 |
|---|---|---|---|---|
| Exome sequence analysis CPT 81415 | $2,456.50 | $4,913.00 | $2,007.60 – $20,678.28 | 68 |
| Exome sequence analysis CPT 81416 | $6,600.00 | $13,200.00 | $5,040.00 – $51,912.00 | 68 |
| Ext ecg>48hr<7d scan a/r CPT 93243 | $131.00 | $262.00 | $87.94 – $361.46 | 63 |
| External chromosome analysis 20-25 cells CPT 88264 | $288.50 | $577.00 | $73.14 – $625.61 | 71 |
| External newborn metabolic screening panel HCPCS S3620 | $71.00 | $142.00 | $6.20 – $683.58 | 15 |
| External tissue culture neoplastic disorders bone marrow/blood cells CPT 88237 | $169.00 | $338.00 | $74.12 – $621.86 | 71 |
| Extractable nuclear antigen/antibody any method each antibody centromere CPT 86235 | $60.50 | $121.00 | $10.53 – $77.58 | 71 |
| Facial bones <3 CPT 70140 | $353.00 | $706.00 | $30.48 – $236.43 | 66 |
| Factor ix CPT 85250 | $30.00 | $60.00 | $11.17 – $82.34 | 71 |
| Factor viii CPT 85240 | $34.00 | $68.00 | $10.51 – $77.44 | 71 |
| Fancc gene CPT 81242 | $33.50 | $67.00 | $15.38 – $158.40 | 71 |
| Fat/lipids feces qualitative CPT 82705 | $9.00 | $18.00 | $2.99 – $22.06 | 71 |
| Fatty acids nonesterified CPT 82725 | $39.50 | $79.00 | $7.81 – $81.18 | 71 |
| Fecal microbiota prep instil HCPCS G0455 | $2,182.00 | $4,364.00 | $871.01 – $6,261.00 | 63 |
| #fecal-sodium CPT 84302 | $9.50 | $19.00 | $2.85 – $21.05 | 71 |
| Fees w/laryngeal sense test CPT 92616 | $432.00 | $864.00 | $79.98 – $215.95 | 56 |
| Felbamate (felbatol(r)) - sendout CPT 80167 | $14.50 | $29.00 | $7.83 – $80.61 | 71 |
| Feno poc CPT 95012 | $105.50 | $211.00 | $22.06 – $101.47 | 56 |
| Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) HCPCS J3010 | $4.00 | $8.00 | $0.93 – $2.10 | 6 |
| Ferritin CPT 82728 | $182.00 | $364.00 | $7.99 – $58.98 | 71 |
| Fetal aneuploidy trisom risk CPT 81507 | $698.50 | $1,397.00 | $333.90 – $3,439.17 | 71 |
| Fetal biophys profile w/nst 76818 CPT 76818 | $754.00 | $1,508.00 | $99.51 – $447.65 | 66 |
| Fetal chrmoml microdeltj CPT 81422 | $698.50 | $1,397.00 | $336.98 – $3,283.65 | 68 |
| Fetal fibronectin CPT 82731 | $1,187.00 | $2,374.00 | $37.80 – $278.67 | 71 |
| Fetal hemoglobin (kleihauer betke) CPT 85460 | $124.00 | $248.00 | $4.54 – $33.45 | 71 |
| Fetal lung maturity assess lam body dnst CPT 83664 | $13.50 | $27.00 | $11.10 – $83.56 | 71 |
| Fetal non stress test CPT 59025 | $750.00 | $1,500.00 | $29.61 – $549.25 | 56 |
| #_fet/norfentcnfrmur CPT 80354 | $57.50 | $115.00 | $0.06 – $183.09 | 44 |
| Fibrin degradation d dimer quantitative CPT 85379 | $235.00 | $470.00 | $5.97 – $44.05 | 71 |
| Fibrin degradation products CPT 85362 | $147.00 | $294.00 | $4.04 – $29.78 | 71 |
| Fibrinogen activity CPT 85384 | $147.00 | $294.00 | $4.99 – $42.03 | 71 |
| Fibrinolysins/coagulopathy screen interpretation/report CPT 85390 | $83.50 | $167.00 | $3.03 – $66.98 | 71 |
| Fibrinolytic antiplasmin CPT 85410 | $30.00 | $60.00 | $4.52 – $33.38 | 71 |
| Fibrinolytic plasminogen CPT 85415 | $40.50 | $81.00 | $10.09 – $74.34 | 71 |
| Fibrinolytic plasminogen xcpt antgnc asa CPT 85420 | $16.00 | $32.00 | $3.83 – $28.26 | 71 |
| Flecainide (tambocor)-sendout CPT 80181 | $14.50 | $29.00 | $7.83 – $80.61 | 71 |
| Flow cytometry interp 16 or more CPT 88189 | $90.00 | $180.00 | $14.62 – $367.57 | 68 |
| Flow cytometry marker each additional CPT 88185 | $122.00 | $244.00 | $4.95 – $98.27 | 16 |
| Flow cytometry one marker technical component CPT 88184 | $331.00 | $662.00 | $4.95 – $973.82 | 72 |
| #flow interp 9 - 15 markers CPT 88188 | $56.50 | $113.00 | $4.95 – $273.26 | 68 |
| Flt3 gene CPT 81245 | $172.50 | $345.00 | $69.69 – $716.03 | 71 |
| Flt3 gene analysis CPT 81246 | $172.50 | $345.00 | $34.88 – $359.06 | 71 |
| Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback HCPCS J1450 | $39.25 | $78.50 | $6.92 – $15.08 | 6 |
| Fluidotherapy charges pt CPT 97022 | $112.00 | $224.00 | $14.03 – $42.50 | 56 |
| Fluorescent antibody titer dna CPT 86256 | $461.50 | $923.00 | $7.07 – $52.13 | 71 |
| Fluoroguide for spine inject 77003-26 CPT 77003 | $333.50 | $667.00 | $116.32 – $365.91 | 6 |
| Fluoroguide needle placement CPT 77002 | $310.00 | $620.00 | $126.07 – $426.18 | 6 |
| Fluoroscopy up to 1 hour CPT 76000 | $216.50 | $433.00 | $40.64 – $648.23 | 66 |
| Folic acid CPT 82746 | $208.00 | $416.00 | $8.63 – $63.59 | 71 |
| Follow-up angiography CPT 75898 | $1,265.00 | $2,530.00 | $127.02 – $13,407.79 | 66 |
| Fomepizole 1 gram/ml intravenous solution HCPCS J1451 | $1,293.87 | $2,587.75 | $6.16 – $2,520.00 | 62 |
| Fondaparinux sodium HCPCS J1652 | $89.50 | $179.00 | $6.81 – $27.84 | 6 |
| Foot X-ray CPT 73630 | $324.00 | $648.00 | $32.69 – $236.43 | 66 |
| Fosaprepitant 150 mg intravenous powder for solution HCPCS J1453 | $498.00 | $996.00 | $25.25 – $516.24 | 6 |
| Fosphenytoin 50 mg pe/ml injection (wrapper) HCPCS Q2009 | $225.62 | $451.25 | $1.34 – $78.39 | 54 |
| _fragile x methylation-sendout CPT 81244 | $356.50 | $713.00 | $18.85 – $194.17 | 71 |
| Fresh frozen plasma 8-24 hours collection each unit HCPCS P9059 | $52.00 | $104.00 | $71.09 – $199.18 | 59 |
| Fresh frozen plasma frozen within 8 hours of collection each unit HCPCS P9017 | $192.50 | $385.00 | $84.29 – $232.15 | 59 |
| Fresh frozen plasma thawing ea un CPT 86927 | $165.50 | $331.00 | $8.58 – $462.86 | 72 |
| Frozen blood thaw CPT 86931 | $116.50 | $233.00 | $22.46 – $462.86 | 72 |
| Frozen plasma, pooled, sd HCPCS P9023 | $159.00 | $318.00 | $55.96 – $151.09 | 60 |
| Fructosamine glycated protein CPT 82985 | $13.00 | $26.00 | $8.85 – $72.53 | 71 |
| Ftl cgen abnor four anal CPT 81511 | $94.00 | $188.00 | $64.47 – $664.04 | 67 |
| Ftl cgen abnor two proteins CPT 81508 | $64.00 | $128.00 | $22.81 – $234.90 | 67 |
| Furosemide 10 mg/ml injection solution HCPCS J1938 | $238.00 | $476.00 | $1.22 – $1.91 | 6 |
| G6pc gene CPT 81250 | $35.50 | $71.00 | $24.57 – $253.00 | 71 |
| G6pd full gene sequence CPT 81249 | $675.00 | $1,350.00 | $252.00 – $2,595.60 | 71 |
| Gabapentin non-blood CPT 80355 | $105.50 | $211.00 | $0.06 – $250.54 | 44 |
| Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper) HCPCS A9579 | $87.50 | $175.00 | $21.15 – $21.15 | 1 |
| Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution HCPCS A9575 | $93.00 | $186.00 | $15.30 – $47.80 | 6 |
| Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution HCPCS A9581 | $264.12 | $528.25 | $393.16 – $393.16 | 1 |
| Galac-1-phosphate uridyltran - sendout CPT 82775 | $220.50 | $441.00 | $12.36 – $91.13 | 71 |
| Galectin-3 CPT 82777 | $157.00 | $314.00 | $7.48 – $191.43 | 68 |
| Gammaglobulin iga CPT 82784 | $15.00 | $30.00 | $5.46 – $40.23 | 71 |
| Gammaglobulin ige CPT 82785 | $11.50 | $23.00 | $9.66 – $71.23 | 71 |
| Gamma glutamyltransferase CPT 82977 | $188.00 | $376.00 | $4.23 – $31.15 | 71 |
| Gastroesophageal reflux test CPT 91034 | $2,012.00 | $4,024.00 | $43.76 – $1,013.78 | 60 |
| Gba gene CPT 81251 | $238.00 | $476.00 | $19.85 – $204.40 | 71 |
| Genetic tstg severe inh cond CPT 81443 | $4,050.00 | $8,100.00 | $1,028.40 – $10,592.50 | 71 |
| Gen, neuro, clo loop, rechg HCPCS C1826 | $14,218.20 | $28,436.40 | $3,650.41 – $3,650.41 | 1 |
| Genome sequence analysis CPT 81425 | $2,516.50 | $5,033.00 | $0.06 – $18,060.71 | 71 |
| Genome sequence analysis CPT 81426 | $2,100.00 | $4,200.00 | $0.06 – $9,728.02 | 71 |
| Gentamicin 10 mg/ml liquid compound - enteral use only HCPCS J1580 | $9.87 | $19.75 | $3.35 – $3.94 | 6 |
| Gentamicin peak therapeutic drug level CPT 80170 | $275.00 | $550.00 | $9.62 – $70.87 | 71 |
| G-esoph reflx tst w/electrod CPT 91035 | $2,104.50 | $4,209.00 | $502.60 – $2,333.00 | 60 |
| Ghs alcohol, methyl (methanol)-medtox CPT 84600 | $115.00 | $230.00 | $9.43 – $74.05 | 71 |
| Ghs alpha thalasemia, 7 deletions CPT 81257 | $94.00 | $188.00 | $42.95 – $442.41 | 71 |
| Ghs antibodies (torch) igm CPT 86694 | $14.00 | $28.00 | $8.45 – $62.22 | 71 |
| Ghs bladder cath - complex-foley CPT 51703 | $291.50 | $583.00 | $57.79 – $6,261.00 | 66 |
| Ghs chemo >8 hrs CPT 96416 | $547.50 | $1,095.00 | $122.26 – $897.37 | 63 |
| Ghs chemo IV push, ea addtl CPT 96411 | $211.00 | $422.00 | $67.99 – $195.61 | 63 |
| Ghs chlamydia pneumoniae by pcr (arup) (306630) CPT 87486 | $200.00 | $400.00 | $20.60 – $151.77 | 71 |
| Ghs community re-entry 15 minutes CPT 97537 | $112.00 | $224.00 | $16.33 – $87.10 | 56 |
| Ghs diphtheria toxoid ab igg CPT 86648 | $80.50 | $161.00 | $8.93 – $65.83 | 71 |
| Ghs eeg cont rec w/video by tec min 8 chnls CPT 95700 | $335.00 | $670.00 | $149.48 – $586.61 | 60 |
| Ghs febrile agglutinns(mayo) CPT 86000 | $22.50 | $45.00 | $4.10 – $30.21 | 71 |
| Ghs fish cytogen CPT 88271 | $167.00 | $334.00 | $12.57 – $92.65 | 71 |
| Ghs fish hybrid in situ 100-300 CPT 88275 | $140.50 | $281.00 | $23.57 – $221.42 | 71 |
| Ghs hepatitis c virus (hcv riba) CPT 86804 | $263.00 | $526.00 | $9.09 – $66.98 | 71 |
| Ghs hgb stability-thal CPT 83068 | $62.50 | $125.00 | $4.97 – $40.95 | 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.