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 |
|---|---|---|---|---|
| Ghs histoplasma antigen CPT 87385 | $85.50 | $171.00 | $7.04 – $57.32 | 71 |
| Ghs HIV antibody CPT 86703 | $172.00 | $344.00 | $8.05 – $59.34 | 71 |
| Ghs inhibitor screen CPT 85335 | $146.50 | $293.00 | $7.56 – $55.66 | 71 |
| Ghs IV inf sq injection, on-body injector CPT 96377 | $168.50 | $337.00 | $39.91 – $127.21 | 60 |
| Ghs IV infusion casirivimab/imdevimab HCPCS M0243 | $285.00 | $570.00 | $430.39 – $430.39 | 4 |
| Ghs leukocyte alkaline phos (mayo) CPT 85540 | $45.00 | $90.00 | $5.05 – $37.20 | 71 |
| Ghs mbp CPT 83873 | $14.50 | $29.00 | $10.10 – $74.41 | 71 |
| Ghs musc test done w/n test comp CPT 95886 | $346.00 | $692.00 | $45.19 – $45.19 | 1 |
| Ghs musc tst done w/nerv tst lim CPT 95885 | $344.00 | $688.00 | $37.82 – $37.82 | 1 |
| Ghs myocardial strain img spckl track CPT 93356 | $320.50 | $641.00 | $20.70 – $20.70 | 1 |
| Ghs o2 saturation CPT 82810 | $224.50 | $449.00 | $5.12 – $42.25 | 71 |
| Ghs ot dds rom CPT 95851 | $73.50 | $147.00 | $6.68 – $78.49 | 56 |
| Ghs ot prosthetic training/15 min CPT 97761 | $112.00 | $224.00 | $20.69 – $109.70 | 56 |
| Ghs ot sensory integrative tech/15min CPT 97533 | $112.00 | $224.00 | $31.16 – $164.73 | 56 |
| Ghs ot work hardening-additional hours CPT 97546 | $335.00 | $670.00 | $7.61 – $7.61 | 1 |
| Ghs path - pap (papanicolau) smear - vagina CPT 88141 | $16.00 | $32.00 | $9.39 – $98.99 | 19 |
| Ghs ppd (tb intradermal) CPT 86580 | $21.00 | $42.00 | $2.71 – $78.58 | 75 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | $10.00 | $20.00 | $5.67 – $41.82 | 71 |
| Ghs protein, misc fluid CPT 84160 | $7.00 | $14.00 | $3.04 – $24.30 | 71 |
| Ghs pr without cont pulse ox CPT 94625 | $64.50 | $129.00 | $11.18 – $160.27 | 60 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | $8.00 | $16.00 | $7.19 – $52.99 | 71 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | $666.00 | $1,332.00 | $16.18 – $16.18 | 1 |
| Ghs sedimentation rate CPT 85651 | $72.00 | $144.00 | $2.08 – $18.46 | 71 |
| Ghs semen analysis fert CPT 89320 | $10.00 | $20.00 | $7.07 – $53.28 | 68 |
| Ghs sensitivity (per antimicro) CPT 87184 | $28.00 | $56.00 | $4.04 – $32.37 | 71 |
| Ghs somatosensory testing lower extremit CPT 95926 | $1,439.50 | $2,879.00 | $36.31 – $586.61 | 60 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $2,880.00 | $5,760.00 | $104.66 – $2,333.00 | 60 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $323.00 | $646.00 | $25.45 – $129.28 | 56 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $324.00 | $648.00 | $45.19 – $278.78 | 56 |
| Ghs st - eval for alt comm CPT 92567 | $33.00 | $66.00 | $22.06 – $101.47 | 60 |
| Ghs st - re-eval for alt comm CPT 92597 | $433.00 | $866.00 | $60.18 – $193.48 | 56 |
| Ghs urine, porphyrins quant CPT 84120 | $22.00 | $44.00 | $8.63 – $63.66 | 71 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | $553.50 | $1,107.00 | $140.34 – $1,013.78 | 60 |
| Giardia ag if CPT 87269 | $35.50 | $71.00 | $7.04 – $58.91 | 71 |
| Giardia lamblia antibody CPT 86674 | $32.50 | $65.00 | $8.64 – $63.66 | 71 |
| Gi inhouse confirmation CPT 87045 | $204.00 | $408.00 | $5.54 – $40.81 | 71 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $2,989.00 | $5,978.00 | $251.62 – $3,132.05 | 63 |
| Gjb2 gene full sequence CPT 81252 | $755.00 | $1,510.00 | $42.47 – $437.43 | 71 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $520.87 | $1,041.75 | $164.86 – $445.13 | 62 |
| Glucagon plasma - sendout CPT 82943 | $48.50 | $97.00 | $8.39 – $61.79 | 71 |
| Glucose 1 hr post dose CPT 82950 | $150.50 | $301.00 | $2.79 – $20.55 | 71 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $21.00 | $42.00 | $1.37 – $14.20 | 68 |
| Glucose blood quantitative CPT 82947 | $106.00 | $212.00 | $2.30 – $17.02 | 71 |
| Glucose body fluid CPT 82945 | $117.00 | $234.00 | $2.30 – $17.02 | 71 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $380.00 | $760.00 | $7.56 – $55.66 | 71 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $6.50 | $13.00 | $10.91 – $80.39 | 71 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $41.50 | $83.00 | $10.87 – $80.10 | 71 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $22.92 | $45.85 | $81.69 – $338.09 | 54 |
| Graft axiofill 1000mg HCPCS J3590 | $234.75 | $469.50 | not published | 0 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $187.50 | $375.00 | $125.22 – $338.09 | 53 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $25.21 | $50.42 | $84.34 – $338.09 | 54 |
| Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 | $143.57 | $287.14 | $125.22 – $338.09 | 54 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $98.44 | $196.88 | $79.30 – $338.09 | 54 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $167.06 | $334.13 | $125.22 – $338.09 | 53 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $242.70 | $485.40 | $109.25 – $338.09 | 54 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $21.56 | $43.13 | $125.22 – $338.09 | 53 |
| Growth hormone antibody CPT 86277 | $103.50 | $207.00 | $9.24 – $68.06 | 71 |
| Growth stimulation gene 2 CPT 83006 | $180.50 | $361.00 | $12.57 – $327.05 | 71 |
| Gu dilat ureter/urethra s&i CPT 74485 | $730.00 | $1,460.00 | $113.65 – $5,679.10 | 66 |
| Guid loc target vol rad tx CPT 77387 | $371.00 | $742.00 | $291.09 – $502.68 | 6 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $2.25 | $4.50 | $1.13 – $9.49 | 6 |
| Handle/convey/speciman/office-lab 99000 CPT 99000 | $12.00 | $24.00 | $2.86 – $19.36 | 11 |
| Hand X-ray CPT 73130 | $283.50 | $567.00 | $35.56 – $236.43 | 66 |
| Haptoglobin quantitative CPT 83010 | $192.00 | $384.00 | $7.38 – $54.44 | 71 |
| Hba1/hba2 full gene sequence CPT 81259 | $450.00 | $900.00 | $252.00 – $2,595.60 | 71 |
| Hba1/hba2 gene dup/del vrnts CPT 81269 | $337.50 | $675.00 | $85.01 – $875.58 | 71 |
| Hbb full gene sequence CPT 81364 | $675.00 | $1,350.00 | $136.32 – $1,404.15 | 71 |
| Hbb gene com variants CPT 81361 | $161.00 | $322.00 | $73.42 – $756.26 | 71 |
| Hbb gene dup/del variants CPT 81363 | $401.50 | $803.00 | $85.01 – $875.58 | 71 |
| Hbot, full body chamber, 30m HCPCS G0277 | $626.50 | $1,253.00 | $131.74 – $373.85 | 59 |
| Hc fl sm bowel enteroclss tube w kub double contrast CPT 74251 | $584.00 | $1,168.00 | $166.31 – $837.30 | 66 |
| Hcg qualitative CPT 84703 | $264.50 | $529.00 | $4.41 – $32.52 | 71 |
| Hcg quantitative CPT 84702 | $289.00 | $578.00 | $8.83 – $65.11 | 71 |
| Hc nm kidney imaging with flow CPT 78701 | $657.50 | $1,315.00 | $200.62 – $1,086.09 | 66 |
| Hc nm myocard infarct avid plnr tomo spect w/wo quant CPT 78469 | $930.50 | $1,861.00 | $317.31 – $1,475.12 | 63 |
| Hdr rdncl ntrstl/icav brchtx CPT 77770 | $2,759.00 | $5,518.00 | $575.04 – $1,892.16 | 63 |
| Hdr rdncl ntrstl/icav brchtx CPT 77771 | $2,759.00 | $5,518.00 | $662.84 – $1,968.04 | 63 |
| Hdr rdncl ntrstl/icav brchtx CPT 77772 | $2,754.00 | $5,508.00 | $662.84 – $2,998.06 | 63 |
| Hdr rdncl skn surf brachytx CPT 77767 | $2,754.00 | $5,508.00 | $251.24 – $1,047.85 | 63 |
| Hdr rdncl skn surf brachytx CPT 77768 | $2,754.00 | $5,508.00 | $251.24 – $1,427.22 | 63 |
| Head CT scan (with and without contrast) CPT 70470 | $2,325.50 | $4,651.00 | $166.31 – $748.12 | 62 |
| Head CT scan (with contrast) CPT 70460 | $2,057.50 | $4,115.00 | $144.74 – $654.17 | 62 |
| Head CT scan (without contrast) CPT 70450 | $1,789.00 | $3,578.00 | $99.51 – $447.65 | 62 |
| Heart first pass add-on CPT 78496 | $1,108.00 | $2,216.00 | $34.10 – $88.11 | 6 |
| Heart infarct image CPT 78466 | $980.00 | $1,960.00 | $165.39 – $1,086.09 | 66 |
| Heinz bodies direct CPT 85441 | $134.50 | $269.00 | $2.47 – $18.17 | 71 |
| Helicobacter pylori antibody igm CPT 86677 | $76.00 | $152.00 | $8.52 – $72.89 | 71 |
| Hematocrit CPT 85014 | $47.00 | $94.00 | $1.39 – $10.24 | 71 |
| Hematopoietic nuclear tx CPT 79403 | $1,565.00 | $3,130.00 | $141.91 – $633.92 | 63 |
| Hemodialysis one evaluation CPT 90935 | $3,026.50 | $6,053.00 | $158.32 – $1,864.56 | 62 |
| Hemoglobin CPT 85018 | $47.00 | $94.00 | $1.39 – $10.24 | 71 |
| Hemoglobin plasma CPT 83051 | $11.50 | $23.00 | $4.29 – $31.65 | 71 |
| Hemolysin acid CPT 85475 | $34.00 | $68.00 | $5.21 – $38.36 | 71 |
| Hemolysins/agglutinins auto CPT 86940 | $47.50 | $95.00 | $4.81 – $37.92 | 71 |
| Hemolysins and agglutinins incubated CPT 86941 | $206.50 | $413.00 | $7.11 – $52.42 | 71 |
| Heparin assay CPT 85520 | $332.00 | $664.00 | $7.68 – $56.60 | 71 |
| Heparin bolus from bag HCPCS J1644 | $33.25 | $66.50 | $0.28 – $0.33 | 6 |
| Heparin neutralization CPT 85525 | $26.50 | $53.00 | $6.95 – $51.19 | 71 |
| Heparin, porcine (pf) 10 unit/ml flush (wrapper) HCPCS J1642 | $1.25 | $2.50 | $1.53 – $3.59 | 6 |
| Hepatitis a antibody igm CPT 86709 | $173.50 | $347.00 | $6.61 – $48.74 | 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.