| CPT | Procedure | Fee Greater Houston | Fee DFW | Fee Austin | Fee San Antonio | Fee Other TX Sites | |||
|---|---|---|---|---|---|---|---|---|---|
| 71020 | CHEST X-RAY 2VW FRONTAL&LATL | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 71021 | CHEST X-RAY FRNT LAT LORDOTC | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 74178 | CT ABD & PELV W/O & W/ DYE | 300-415 | 400-475 | 350 | 400 | 350-500 | |||
| 74177 | CT ABD & PELV W/CONTRAST | 275-375 | 375-400 | 350 | 325 | 350-500 | |||
| 74176 | CT ABD & PELVIS W/O CONTRAST | 225-325 | 275-400 | 250 | 275 | 250-450 | |||
| 74160 | CT ABDOMEN W/DYE | 275-375 | 375-400 | 350 | 325 | 350-500 | |||
| 74170 | CT ABDOMEN W/O & W/DYE | 300-415 | 400-475 | 350 | 400 | 350-500 | |||
| 74150 | CT ABDOMEN W/O DYE | 225-325 | 275-400 | 250 | 275 | 250-450 | |||
| 71275 | CT ANGIOGRAPHY CHEST | 275-375 | 375-500 | 350 | 325 | 350-500 | |||
| 72127 | CT C-SPINE W/O & W/DYE | 300-415 | 400-475 | 350 | 400 | 350-500 | |||
| 72125 | CT C-SPINE W/O DYE | 225-325 | 275-400 | 250 | 275 | 250-450 | |||
| 70470 | CT HEAD/BRAIN W/O & W/DYE | 300-415 | 400-475 | 350 | 400 | 350-500 | |||
| 70450 | CT HEAD/BRAIN W/O DYE | 225-325 | 275-400 | 250 | 275 | 250-450 | |||
| 73702 | CT LOWER EXTREMITY W/O & W/DYE | 300-415 | 400-475 | 350 | 400 | 350-500 | |||
| 73700 | CT LOWER EXTREMITY W/O DYE | 225-325 | 275-400 | 250 | 275 | 250-450 | |||
| 72133 | CT LUMBAR SPINE W/O & W/DYE | 300-415 | 400-475 | 350 | 400 | 350-500 | |||
| 72131 | CT LUMBAR SPINE W/O DYE | 225-325 | 275-400 | 250 | 275 | 250-450 | |||
| 70486 | CT MAXILLOFACIAL W/O DYE | 225-325 | 275-400 | 250 | 275 | 250-450 | |||
| 70480 | CT ORBIT/EAR/FOSSA W/O DYE | 225-325 | 275-400 | 250 | 275 | 250-450 | |||
| 72194 | CT PELVIS W/O & W/DYE | 300-415 | 400-475 | 350 | 400 | 350-500 | |||
| 72192 | CT PELVIS W/O DYE | 225-325 | 275-400 | 250 | 275 | 250-450 | |||
| 70492 | CT SFT TSUE NCK W/O & W/DYE | 300-415 | 400-475 | 350 | 400 | 350-500 | |||
| 70491 | CT SOFT TISSUE NECK W/DYE | 275-375 | 375-400 | 350 | 325 | 250-450 | |||
| 70490 | CT SOFT TISSUE NECK W/O DYE | 225-325 | 275-400 | 250 | 275 | 250-450 | |||
| 72128 | CT THORACIC SPINE W/O DYE | 225-325 | 275-400 | 250 | 275 | 250-450 | |||
| 71260 | CT THORAX W/DYE | 275-375 | 375-400 | 350 | 325 | 350-500 | |||
| 71270 | CT THORAX W/O & W/DYE | 300-415 | 400-475 | 350 | 400 | 350-500 | |||
| 71250 | CT THORAX W/O DYE | 225-325 | 275-400 | 250 | 275 | 250-450 | |||
| 73200 | CT UPPER EXTREMITY W/O DYE | 225-325 | 275-400 | 250 | 275 | 250-450 | |||
| 73202 | CT UPPR EXTREMITY W/O&W/DYE | 300-415 | 400-475 | 350 | 400 | 350-500 | |||
| 77080 | DXA BONE DENSITY AXIAL | 75 | 75 | ||||||
| 93880 | EXTRACRANIAL BILAT STUDY | 200-250 | 250 | 150-250 | 250 | 150-250 | |||
| 93970 | EXTREMITY STUDY | 150-200 | 250 | 150-200 | 200 | 150-200 | |||
| 93971 | EXTREMITY STUDY | 150-200 | 250 | 150-200 | 200 | 150-200 | |||
| 78227 | HEPATOBIL SYST IMAGE W/DRUG | 400-500 | 250 | ||||||
| 93925 | LOWER EXTREMITY DOPPLER | 150-275 | 250 | 150-275 | 275 | 150-275 | |||
| 93926 | LOWER EXTREMITY DOPPLER | 150-275 | 250 | 150-275 | 275 | 150-275 | |||
| 70544 | MR ANGIOGRAPHY HEAD W/O DYE | 250-450 | 425-500 | 350-425 | 350 | 350-550 | |||
| 70547 | MR ANGIOGRAPHY NECK W/O DYE | 250-450 | 425-500 | 350-425 | 350 | 350-550 | |||
| 74183 | MRI ABDOMEN W/O & W/DYE | 450-600 | 600-675 | 525-600 | 600 | 525-690 | |||
| 74181 | MRI ABDOMEN W/O DYE | 250-475 | 475-500 | 425-475 | 475 | 425-550 | |||
| 77059 | MRI BOTH BREASTS | 450 | |||||||
| 70553 | MRI BRAIN STEM W/O & W/DYE | 450-550 | 475-675 | 475-525 | 475 | 475-690 | |||
| 70551 | MRI BRAIN STEM W/O DYE | 250-450 | 425-500 | 350-425 | 350 | 350-550 | |||
| 72157 | MRI CHEST SPINE W/O & W/DYE | 450-600 | 600-675 | 525-600 | 600 | 525-690 | |||
| 71550 | MRI CHEST W/O DYE | 250-475 | 475-500 | 425-475 | 475 | 425-550 | |||
| 72141 | MRI C-SPINE W/O DYE | 250-450 | 425-500 | 350-425 | 350 | 350-550 | |||
| 73721 | MRI JNT OF LWR EXTRE W/O DYE | 250-450 | 425-500 | 350-425 | 350 | 350-550 | |||
| 73723 | MRI JOINT LWR EXTR W/O&W/DYE | 450-550 | 475-525 | 475 | 475-690 | ||||
| 73223 | MRI JOINT UPR EXTR W/O&W/DYE | 450-550 | 475-675 | 475-525 | 475 | 475-690 | |||
| 73221 | MRI JOINT UPR EXTREM W/O DYE | 250-450 | 425-500 | 350-425 | 350 | 350-550 | |||
| 73718 | MRI LOWER EXTREMITY W/O DYE | 250-450 | 425-500 | 350-425 | 350 | 350-550 | |||
| 72158 | MRI LUMBAR SPINE W/O & W/DYE | 450-550 | 475-675 | 475-525 | 475 | 475-690 | |||
| 72148 | MRI LUMBAR SPINE W/O DYE | 250-450 | 425-500 | 350-425 | 350 | 350-550 | |||
| 73720 | MRI LWR EXTREMITY W/O&W/DYE | 450-550 | 475-675 | 475-525 | 475 | 475-690 | |||
| 72156 | MRI NECK SPINE W/O & W/DYE | 450-550 | 475-675 | 475-525 | 475 | 475-690 | |||
| 70540 | MRI ORBIT/FACE/NECK W/O DYE | 250-450 | 425-500 | 350-425 | 350 | 350-550 | |||
| 70543 | MRI ORBT/FAC/NCK W/O &W/DYE | 450-550 | 475-675 | 475-525 | 475 | 475-690 | |||
| 72197 | MRI PELVIS W/O & W/DYE | 400-600 | 600-675 | 525-600 | 600 | 525-690 | |||
| 72195 | MRI PELVIS W/O DYE | 250-475 | 475-500 | 425-475 | 475 | 425-550 | |||
| 72146 | MRI THORACIC SPINE W/O DYE | 250-450 | 425-500 | 350-425 | 350 | 350-550 | |||
| 70336 | MRI TMJ | 350-450 | 425 | 425 | 400 | 450-625 | |||
| 73218 | MRI UPPER EXTREMITY W/O DYE | 250-450 | 425-500 | 350-425 | 350 | 350-550 | |||
| 73220 | MRI UPPR EXTREMITY W/O&W/DYE | 400-550 | 475-675 | 475-525 | 475 | 475-690 | |||
| 76801 | OB US < 14 WKS SINGLE FETUS | 150 | 175 | 150 | 175 | 150-325 | |||
| 78070 | PARATHYROID PLANAR IMAGING | 500 | |||||||
| 78816 | PET IMAGE W/CT FULL BODY | 800-1400 | 1750 | 1650 | |||||
| 78815 | PET IMAGE W/CT SKULL-THIGH | 800-1400 | 1750 | 1650 | |||||
| 76817 | TRANSVAGINAL US OBSTETRIC | 150 | 175 | 150 | 150 | 150-325 | |||
| 76641 | ULTRASOUND BREAST COMPLETE | 150 | 175 | 150 | 150 | 150-325 | |||
| 76770 | US EXAM ABDO BACK WALL COMP | 150 | 175 | 150 | 150 | 150-325 | |||
| 76700 | US EXAM ABDOM COMPLETE | 150 | 175 | 150 | 150 | 150-325 | |||
| 76705 | US EXAM OF ABDOMEN | 150 | 175 | 150 | 150 | 150-325 | |||
| 76536 | US EXAM OF HEAD AND NECK | 150 | 175 | 150 | 150 | 150-325 | |||
| 76856 | US EXAM PELVIC COMPLETE | 150 | 175 | 150 | 150 | 150-325 | |||
| 76870 | US EXAM SCROTUM | 150 | 175 | 150 | 150 | 150-325 | |||
| 93975 | VASCULAR STUDY | 150-300 | 200 | 150 | 150 | 150-325 | |||
| 72040 | X-RAY EXAM C-SPINE 2-3 VW | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 72050 | X-RAY EXAM CSPINE 4/5VWS | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 72052 | X-RAY EXAM C-SPINE 6/>VWS | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73564 | X-RAY EXAM KNEE 4 OR MORE | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 72110 | X-RAY EXAM L-2 SPINE 4/>VWS | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 72100 | X-RAY EXAM L-S SPINE 2/3 VWS | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 72114 | X-RAY EXAM L-S SPINE BENDING | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 74000 | X-RAY EXAM OF ABDOMEN | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 74010 | X-RAY EXAM OF ABDOMEN | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 74020 | X-RAY EXAM OF ABDOMEN | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73600 | X-RAY EXAM OF ANKLE | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73610 | X-RAY EXAM OF ANKLE | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73000 | X-RAY EXAM OF COLLAR BONE | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73070 | X-RAY EXAM OF ELBOW | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73080 | X-RAY EXAM OF ELBOW | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73140 | X-RAY EXAM OF FINGER(S) | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73620 | X-RAY EXAM OF FOOT | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73630 | X-RAY EXAM OF FOOT | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73090 | X-RAY EXAM OF FOREARM | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73120 | X-RAY EXAM OF HAND | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73130 | X-RAY EXAM OF HAND | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73520 | X-RAY EXAM OF HIPS | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73060 | X-RAY EXAM OF HUMERUS | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73560 | X-RAY EXAM OF KNEE 1 OR 2 | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73562 | X-RAY EXAM OF KNEE 3 | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73565 | X-RAY EXAM OF KNEES | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73590 | X-RAY EXAM OF LOWER LEG | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 70360 | X-RAY EXAM OF NECK | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 72170 | X-RAY EXAM OF PELVIS | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 72190 | X-RAY EXAM OF PELVIS | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73030 | X-RAY EXAM OF SHOULDER | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 70220 | X-RAY EXAM OF SINUSES | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 70250 | X-RAY EXAM OF SKULL | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73660 | X-RAY EXAM OF TOE(S) | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 73110 | X-RAY EXAM OF WRIST | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 71110 | X-RAY EXAM RIBS BIL 3 VIEWS | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 72220 | X-RAY EXAM SACRUM COCCYX | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 72202 | X-RAY EXAM SI JOINTS 3/> VWS | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 72070 | X-RAY EXAM THORAC SPINE 2VWS | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 72072 | X-RAY EXAM THORAC SPINE 3VWS | 50-75 | 75 | 50 | 75-90 | 50-120 | |||
| 77074 | X-RAYS BONE SURVEY LIMITED | 200 | 200 | 200 | 200 | 200 | |||
| 75571 | CALCIUM SCORE CT | 150 | 150 |
Exams include contrast and interpretation
Other geographic regions and exams available
Not every exam is available at every site
