Prices / Houston–Pasadena–The Woodlands, TX / Hospitals
Ad Hospital East, Llc
12950 East Freeway, Suite 100, Houston, TX 77015 · CCN 670102
Source: the hospital's standard-charges file dated 2026-07-20 (original file, csv_tall, 2 MB), checked by us on 2026-10-06. 80 of 300 common services found in it.
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Laboratory & Pathology
| Service | Code | Cash price | Insurers pay (min – median – max) | Gross charge |
|---|---|---|---|---|
| Automated Urinalysis Test | CPT 81002 | $100.00 | $2.09 – $3.48 – $18.59 6 insurers | $100.00 |
| Automated Urinalysis Test | CPT 81003 | $73.00 | $1.51 – $2.25 – $73.00 7 insurers | $73.00 |
| Basic Metabolic Panel | CPT 80048 | $723.00 | $6.77 – $8.46 – $723.00 10 insurers | $723.00 |
| Blood Test, Clotting Time | CPT 85610 | $100.00 | $2.88 – $4.29 – $233.00 10 insurers | $233.00 |
| Blood Test, Comprehensive Group of Blood Chemicals | CPT 80053 | $150.00 | $7.10 – $69.17 – $985.00 11 insurers | $985.00 |
| Blood Test, Lipids (Cholesterol and Triglycerides) | CPT 80061 | $72.96 | $12.05 – $12.72 – $13.39 2 insurers | $981.00 |
| Blood Test, Thyroid Stimulating Hormone (Tsh) | CPT 84443 | $150.00 | $16.80 – $16.80 – $16.80 1 insurers | $150.00 |
| Coagulation Assessment Blood Test | CPT 85730 | $100.00 | $4.81 – $127.26 – $452.00 6 insurers | $452.00 |
| Complete Blood Cell Count, With Differential White Blood Cells, Automated | CPT 85025 | $119.00 | $5.22 – $9.52 – $119.00 17 insurers | $125.00 |
| Manual Urinalysis Test With Examination Using Microscope | CPT 81001 | $150.00 | $2.13 – $2.85 – $3.17 3 insurers | $150.00 |
| Psa (Prostate Specific Antigen) | CPT 84153 | $572.00 | $16.55 – $16.55 – $16.55 1 insurers | $572.00 |
Medicine & Surgery
| Service | Code | Cash price | Insurers pay (min – median – max) | Gross charge |
|---|---|---|---|---|
| Electrocardiogram, Routine, With Interpretation and Report | CPT 93000 | $850.00 | $92.65 – $471.33 – $850.00 4 insurers | $850.00 |
| Injections of Anesthetic and/Or Steroid Drug Into Lower Or Sacral Spine Nerve Root Using Imaging Guidance | CPT 64483 | $3,296.00 | $658.63 – $832.85 – $879.80 2 insurers | $3,296.00 |
| Removal of One Knee Cartilage Using An Endoscope | CPT 29881 | $12,971.14 | $3,207.02 – $5,356.00 – $19,021.19 3 insurers | $12,971.14 |
Radiology
| Service | Code | Cash price | Insurers pay (min – median – max) | Gross charge |
|---|---|---|---|---|
| Abdominal Ultrasound of Pregnant Uterus (>= 14 Weeks 0 Days) Single Or First Fetus | CPT 76805 | $448.22 | $83.80 – $83.80 – $83.80 1 insurers | $2,046.00 |
| Ct Scan, Head Or Brain, Without Contrast | CPT 70450 | $4,979.00 | $83.80 – $106.51 – $625.00 18 insurers | $4,979.00 |
| Ct Scan of Abdomen and Pelvis With Contrast | CPT 74177 | $11,642.00 | $249.66 – $357.71 – $11,642.00 18 insurers | $11,642.00 |
| Mammography of Both Breasts | CPT 77066 | $1,242.00 | $87.16 – $106.87 – $181.09 10 insurers | $1,242.00 |
| Mammography of One Breast | CPT 77065 | $972.40 | $68.47 – $84.15 – $142.05 9 insurers | $972.40 |
| Mammography, Screening, Bilateral | CPT 77067 | $616.26 | $72.00 – $90.00 – $150.19 23 insurers | $616.26 |
| Mri Scan of Brain Before and After Contrast | CPT 70553 | $5,141.00 | $262.49 – $357.71 – $842.51 11 insurers | $7,500.00 |
| Mri Scan of Leg Joint | CPT 73721 | $6,923.00 | $111.40 – $311.86 – $900.00 11 insurers | $6,923.00 |
| Mri Scan of Lower Spinal Canal | CPT 72148 | $6,158.00 | $97.02 – $279.57 – $900.00 17 insurers | $6,158.00 |
| Ultrasound of Abdomen | CPT 76700 | $566.65 | $83.80 – $105.55 – $304.66 14 insurers | $1,895.00 |
| Ultrasound Pelvis Through Vagina | CPT 76830 | $448.88 | $66.39 – $102.42 – $139.47 7 insurers | $1,192.00 |
| X-Ray, Lower Back, Minimum Four Views | CPT 72110 | $1,155.53 | $41.70 – $106.51 – $171.01 5 insurers | $1,155.53 |
Outpatient/professional (volume)
| Service | Code | Cash price | Insurers pay (min – median – max) | Gross charge |
|---|---|---|---|---|
| Aspiration and/Or Injection of Fluid From Large Joint | CPT 20610 | $2,390.00 | $218.21 – $289.76 – $387.16 12 insurers | $3,982.00 |
| Complete Ultrasound Scan Behind Abdominal Cavity | CPT 76770 | $1,754.00 | $57.42 – $102.92 – $106.51 10 insurers | $1,754.00 |
| Ct Scan of Abdomen and Pelvis Before and After Contrast | CPT 74178 | $9,374.00 | $195.06 – $357.39 – $625.00 12 insurers | $9,374.00 |
| Ct Scan of Abdomen and Pelvis Without Contrast | CPT 74176 | $10,701.00 | $150.49 – $242.11 – $4,661.97 17 insurers | $10,701.00 |
| Ct Scan of Blood Vessels of Chest With Contrast | CPT 71275 | $4,580.69 | $174.74 – $205.90 – $421.06 8 insurers | $4,580.69 |
| Ct Scan of Blood Vessels of Head With Contrast | CPT 70496 | $6,510.00 | $140.05 – $233.48 – $435.82 6 insurers | $6,510.00 |
| Ct Scan of Blood Vessels of Neck With Contrast | CPT 70498 | $6,557.00 | $154.74 – $414.94 – $625.00 3 insurers | $6,557.00 |
| Ct Scan of Chest With Contrast | CPT 71260 | $7,164.00 | $137.39 – $176.14 – $625.00 8 insurers | $7,164.00 |
| Ct Scan of Chest Without Contrast | CPT 71250 | $5,260.00 | $66.17 – $106.51 – $5,260.00 14 insurers | $5,260.00 |
| Ct Scan of Face Without Contrast | CPT 70486 | $4,845.00 | $83.80 – $216.48 – $435.82 8 insurers | $4,845.00 |
| Ct Scan of Leg Without Contrast | CPT 73700 | $3,975.00 | $66.70 – $104.78 – $625.00 9 insurers | $3,975.00 |
| Ct Scan of Lower Spine Without Contrast | CPT 72131 | $5,758.00 | $83.80 – $103.43 – $625.00 13 insurers | $5,758.00 |
| Ct Scan of Upper Spine Without Contrast | CPT 72125 | $6,817.00 | $83.80 – $136.64 – $6,817.00 14 insurers | $6,817.00 |
| Destruction of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance, Single Facet Joint | CPT 64635 | $7,897.00 | $875.50 – $1,280.59 – $8,208.44 12 insurers | $7,897.00 |
| Diagnostic Digital Breast Tomosynthesis, Unilateral Or Bilateral (List Separately In Addition To 77065 Or 77066) | HCPCS G0279 | $258.70 | $14.21 – $15.10 – $22.11 8 insurers | $258.70 |
| Dxa Bone Density Measurement of Hip, Pelvis, Spine | CPT 77080 | $1,120.00 | $23.46 – $104.91 – $171.01 14 insurers | $1,120.00 |
| Emergency Department Visit With High Level of Medical Decision Making | CPT 99285 | $7,100.00 | $355.00 – $890.43 – $3,845.43 23 insurers | $7,100.00 |
| Emergency Department Visit With Low Level of Medical Decision Making | CPT 99283 | $2,750.00 | $51.36 – $402.14 – $4,160.00 28 insurers | $4,160.00 |
| Emergency Department Visit With Moderate Level of Medical Decision Making | CPT 99284 | $5,450.00 | $272.50 – $558.48 – $2,577.17 26 insurers | $5,450.00 |
| Established Patient Office Or Other Outpatient Visit With Moderate Level of Decision Making, If Using Time, 30 Minutes Or More | CPT 99214 | $1,000.00 | $1,000.00 – $1,000.00 – $1,000.00 2 insurers | $1,000.00 |
| Imaging For Evaluation of Swallowing Function | CPT 74230 | $1,227.00 | $171.91 – $171.91 – $171.91 1 insurers | $1,227.00 |
| Injection of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Level | CPT 64493 | $3,296.00 | $275.00 – $668.80 – $1,167.66 15 insurers | $3,296.00 |
| Limited Ultrasound Scan of 1 Breast | CPT 76642 | $560.80 | $43.32 – $86.43 – $139.01 11 insurers | $560.80 |
| Limited Ultrasound Scan of Abdomen | CPT 76705 | $1,406.00 | $46.80 – $104.38 – $171.01 16 insurers | $1,406.00 |
| Low Dose Ct Scan of Chest For Lung Cancer Screening | CPT 71271 | $6,817.00 | $69.51 – $104.91 – $6,817.00 8 insurers | $6,817.00 |
| Mri Scan of Abdomen Before and After Contrast | CPT 74183 | $4,400.00 | $321.94 – $405.17 – $900.00 4 insurers | $4,400.00 |
| Mri Scan of Brain Without Contrast | CPT 70551 | $4,800.00 | $101.43 – $242.11 – $900.00 20 insurers | $14,800.00 |
| Mri Scan of Upper Spinal Canal Without Contrast | CPT 72141 | $6,334.00 | $97.58 – $307.87 – $900.00 6 insurers | $6,334.00 |
| Removal of Skin and Tissue, 20.0 Sq Cm Or Less | CPT 11042 | $2,583.00 | $394.38 – $394.38 – $400.18 2 insurers | $2,583.00 |
| Screening 3d Breast Mammography | CPT 77063 | $258.70 | $18.69 – $23.36 – $39.04 23 insurers | $258.70 |
| Test To Measure Expiratory Airflow and Volume Changes Before and After Medication Administration | CPT 94060 | $3,491.20 | $306.91 – $311.90 – $452.26 5 insurers | $3,491.20 |
| Ultrasonic Guidance For Blood Vessel Access | CPT 76937 | $2,451.00 | $29.35 – $122.55 – $2,451.00 3 insurers | $2,451.00 |
| Ultrasonic Guidance For Needle Placement | CPT 76942 | $1,200.00 | $34.03 – $1,200.00 – $1,200.00 4 insurers | $1,200.00 |
| Ultrasound of Both Sides of Head and Neck Blood Flow | CPT 93880 | $2,607.99 | $189.82 – $237.87 – $365.00 10 insurers | $2,607.99 |
| Ultrasound of Heart With Color-Depicted Blood Flow, Rate, Direction and Valve Function | CPT 93306 | $949.70 | $148.02 – $536.29 – $769.00 11 insurers | $1,764.08 |
| Ultrasound Scan of Head and Neck Soft Tissue | CPT 76536 | $1,384.00 | $65.38 – $106.51 – $1,384.00 11 insurers | $1,384.00 |
| Ultrasound Study of Arm Or Leg Veins With Compression and Maneuvers | CPT 93970 | $2,909.00 | $217.74 – $237.27 – $351.06 12 insurers | $2,909.00 |
| Ultrasound Study of One Arm Or Leg Veins With Compression and Maneuvers | CPT 93971 | $578.35 | $95.81 – $104.65 – $365.00 11 insurers | $1,730.00 |
| X-Ray of Abdomen, 1 View | CPT 74018 | $47.65 | $24.06 – $86.04 – $115.87 5 insurers | $621.10 |
| X-Ray of Ankle, Minimum of 3 Views | CPT 73610 | $178.45 | $29.40 – $83.93 – $127.88 11 insurers | $765.00 |
| X-Ray of Chest, 1 View | CPT 71045 | $621.10 | $20.58 – $86.81 – $621.10 20 insurers | $621.10 |
| X-Ray of Chest, 2 Views | CPT 71046 | $621.10 | $18.41 – $87.13 – $139.01 21 insurers | $621.10 |
| X-Ray of Foot, Minimum of 3 Views | CPT 73630 | $167.10 | $27.53 – $86.71 – $758.00 14 insurers | $758.00 |
| X-Ray of Hand, Minimum of 3 Views | CPT 73130 | $183.30 | $29.94 – $86.78 – $139.01 6 insurers | $653.00 |
| X-Ray of Hip, 2-3 Views | CPT 73502 | $233.70 | $30.35 – $86.86 – $139.01 12 insurers | $482.00 |
| X-Ray of Knee, 1-2 Views | CPT 73560 | $167.05 | $20.35 – $65.22 – $564.00 4 insurers | $564.00 |
| X-Ray of Knee, 3 Views | CPT 73562 | $615.20 | $32.31 – $88.19 – $615.20 15 insurers | $615.20 |
| X-Ray of Knee, 4 Or More Views | CPT 73564 | $758.05 | $100.52 – $105.55 – $106.51 4 insurers | $758.05 |
| X-Ray of Lower and Sacral Spine, 2-3 Views | CPT 72100 | $194.75 | $23.72 – $105.16 – $171.01 12 insurers | $1,156.00 |
| X-Ray of Lower Leg, 2 Views | CPT 73590 | $155.70 | $18.94 – $86.96 – $139.01 6 insurers | $784.00 |
| X-Ray of Pelvis, 1-2 Views | CPT 72170 | $638.00 | $102.48 – $136.75 – $171.01 2 insurers | $638.00 |
| X-Ray of Shoulder, Minimum of 2 Views | CPT 73030 | $170.35 | $27.80 – $86.78 – $139.01 15 insurers | $801.00 |
| X-Ray of Thigh Bone, Minimum 2 Views | CPT 73552 | $175.20 | $83.78 – $83.94 – $88.19 3 insurers | $906.00 |
| X-Ray of Wrist, Minimum of 3 Views | CPT 73110 | $673.00 | $19.35 – $84.06 – $115.48 8 insurers | $673.00 |