Physician Cost of Services Aff: Follows Texas Civil Practice Code 18.001 for fees above usual and customary. A physician medical review must be completed to execute this affidavit. See above for physician medical review pricing.
Cost of Affidavits: 1 Provider= $500 - 2 + Providers = $225 per additional affidavit
PLEASE NOTE: MDs will sign off on MRI and ESI charges only. DCs will sign off on Office Visits, X-rays and possibly MRIs only.