|
Abdominal CT scan (with and without contrast)
|
$1,509.20 |
$1,509.20 |
$1,509.20 |
$2,049.00
|
|
Abdominal CT scan (with contrast)
|
$1,325.95 |
$1,325.95 |
$1,325.95 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$861.85 |
$861.85 |
$861.85 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$2,456.90 |
$2,456.90 |
$2,456.90 |
$3,061.80
|
|
Abdominal MRI (without contrast)
|
$1,624.80 |
$1,624.80 |
$1,624.80 |
$1,902.00
|
|
Abdominal Ultrasound (complete)
|
$924.60 |
$924.60 |
$924.60 |
$755.00
|
|
Abdominal Ultrasound (limited)
|
$844.10 |
$844.10 |
$844.10 |
$629.42
|
|
Ankle X-ray
|
$237.45 |
$237.45 |
$237.45 |
$312.74
|
|
Blood Clotting (PT/INR) Test
|
$90.60 |
$90.60 |
$90.60 |
$45.00
|
|
Blood Clotting (PTT) Test
|
$190.05 |
$190.05 |
$190.05 |
$64.35
|
|
Blood Count (CBC) Test
|
$105.05 |
$105.05 |
$105.05 |
$66.75
|
|
Blood Count (CBC) Test (without differential)
|
$79.70 |
$79.70 |
$79.70 |
$57.50
|
|
Blood Culture Test
|
$399.85 |
$399.85 |
$399.85 |
$112.20
|
|
Bone Density Scan (DEXA)
|
$219.50 |
$219.50 |
$219.50 |
$398.56
|
|
Brain MRA (blood vessel MRI, without contrast)
|
$1,884.20 |
$1,884.20 |
$1,884.20 |
$1,802.40
|
|
Brain MRI (with and without contrast)
|
$2,174.90 |
$2,174.90 |
$2,174.90 |
$2,919.75
|
|
Brain MRI (with contrast)
|
$1,844.85 |
$1,844.85 |
$1,844.85 |
$2,224.96
|
|
Brain MRI (without contrast)
|
$1,330.10 |
$1,330.10 |
$1,330.10 |
$1,830.00
|
|
Breast Biopsy (ultrasound-guided, percutaneous)
|
$5,542.20 |
$5,542.20 |
$5,542.20 |
$3,069.25
|
|
CT Angiogram of Abdomen and Pelvis
|
$2,229.85 |
$2,229.85 |
$2,229.85 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$2,658.80 |
$2,658.80 |
$2,658.80 |
$2,094.23
|
|
CT Angiogram of the Head
|
$2,658.80 |
$2,658.80 |
$2,658.80 |
$2,094.23
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$2,029.70 |
$2,029.70 |
$2,029.70 |
$3,669.25
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$1,791.20 |
$1,791.20 |
$1,791.20 |
$3,217.18
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,153.85 |
$1,153.85 |
$1,153.85 |
$2,418.75
|
|
Carotid Artery Ultrasound (Duplex)
|
$1,407.45 |
$1,407.45 |
$1,407.45 |
$1,059.82
|
|
Chest CT scan (with and without contrast)
|
$2,649.25 |
$2,649.25 |
$2,649.25 |
$2,105.40
|
|
Chest CT scan (with contrast)
|
$1,129.80 |
$1,129.80 |
$1,129.80 |
$1,697.25
|
|
Chest CT scan (without contrast)
|
$936.55 |
$936.55 |
$936.55 |
$1,350.03
|
|
Chest X-ray
|
$391.40 |
$391.40 |
$391.40 |
$303.24
|
|
Chest X-ray (single view)
|
$346.05 |
$346.05 |
$346.05 |
$225.00
|
|
Cholesterol (Lipid) Test
|
$201.65 |
$201.65 |
$201.65 |
$100.00
|
|
Circumcision (newborn)
|
$283.40 |
$283.40 |
$283.40 |
$1,549.50
|
|
Diabetes (HbA1c) Test
|
$30.25 |
$30.25 |
$30.25 |
$70.00
|
|
Diagnostic Mammogram (both breasts)
|
$395.80 |
$395.80 |
$395.80 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$279.55 |
$279.55 |
$279.55 |
$297.05
|
|
ER Visit (level 1, minor)
|
$214.05 |
$214.05 |
$214.05 |
$286.51
|
|
ER Visit (level 2)
|
$351.30 |
$351.30 |
$351.30 |
$469.39
|
|
ER Visit (level 3)
|
$926.75 |
$926.75 |
$926.75 |
$827.20
|
|
ER Visit (level 4)
|
$1,754.55 |
$1,754.55 |
$1,754.55 |
$1,330.00
|
|
ER Visit (level 5, high severity)
|
$3,306.00 |
$3,306.00 |
$3,306.00 |
$1,892.80
|
|
Echocardiogram (Heart Ultrasound)
|
$1,780.25 |
$1,780.25 |
$1,780.25 |
$2,021.12
|
|
Established Patient Office Visit (level 1)
|
$165.30 |
$165.30 |
$165.30 |
$115.05
|
|
Established Patient Office Visit (level 2)
|
$352.80 |
$352.80 |
$352.80 |
$127.53
|
|
Established Patient Office Visit (level 3)
|
$352.80 |
$352.80 |
$352.80 |
$183.60
|
|
Established Patient Office Visit (level 4)
|
$352.80 |
$352.80 |
$352.80 |
$228.60
|
|
Established Patient Office Visit (level 5)
|
$396.35 |
$396.35 |
$396.35 |
$306.40
|
|
Foot X-ray
|
$225.70 |
$225.70 |
$225.70 |
$339.50
|
|
Hand X-ray
|
$230.60 |
$230.60 |
$230.60 |
$315.00
|
|
Head CT scan (with and without contrast)
|
$2,649.25 |
$2,649.25 |
$2,649.25 |
$1,914.25
|
|
Head CT scan (with contrast)
|
$2,233.90 |
$2,233.90 |
$2,233.90 |
$1,587.69
|
|
Head CT scan (without contrast)
|
$1,692.70 |
$1,692.70 |
$1,692.70 |
$1,268.90
|
|
Hip X-ray
|
$200.25 |
$200.25 |
$200.25 |
$290.35
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$924.60 |
$924.60 |
$924.60 |
$683.50
|
|
Knee MRI (with and without contrast)
|
$2,703.85 |
$2,703.85 |
$2,703.85 |
$3,008.26
|
|
Knee MRI (with contrast)
|
$2,197.30 |
$2,197.30 |
$2,197.30 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$1,366.70 |
$1,366.70 |
$1,366.70 |
$2,209.22
|
|
Knee X-ray
|
$311.20 |
$311.20 |
$311.20 |
$387.20
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,407.45 |
$1,407.45 |
$1,407.45 |
$1,090.23
|
|
Liver Function Test
|
$203.95 |
$203.95 |
$203.95 |
$93.60
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$2,649.25 |
$2,649.25 |
$2,649.25 |
$1,909.80
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$1,310.45 |
$1,310.45 |
$1,310.45 |
$1,850.88
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$2,649.25 |
$2,649.25 |
$2,649.25 |
$1,517.10
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$2,183.30 |
$2,183.30 |
$2,183.30 |
$2,750.00
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$1,854.70 |
$1,854.70 |
$1,854.70 |
$2,415.68
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$1,293.45 |
$1,293.45 |
$1,293.45 |
$2,013.08
|
|
Lower Back (Lumbar Spine) X-ray
|
$263.85 |
$263.85 |
$263.85 |
$341.64
|
|
Lung Function Test (Spirometry)
|
$313.30 |
$313.30 |
$313.30 |
$296.91
|
|
Metabolic Blood Panel (Basic)
|
$196.30 |
$196.30 |
$196.30 |
$97.60
|
|
Metabolic Blood Panel (Comprehensive)
|
$204.95 |
$204.95 |
$204.95 |
$130.97
|
|
Neck (Cervical Spine) CT scan (with and without contrast)
|
$2,649.25 |
$2,649.25 |
$2,649.25 |
$1,992.00
|
|
Neck (Cervical Spine) CT scan (with contrast)
|
$2,233.90 |
$2,233.90 |
$2,233.90 |
$1,708.20
|
|
Neck (Cervical Spine) CT scan (without contrast)
|
$1,060.75 |
$1,060.75 |
$1,060.75 |
$1,513.95
|
|
Neck (Cervical Spine) MRI (with and without contrast)
|
$2,187.60 |
$2,187.60 |
$2,187.60 |
$2,750.00
|
|
Neck (Cervical Spine) MRI (with contrast)
|
$1,878.55 |
$1,878.55 |
$1,878.55 |
$2,231.16
|
|
Neck (Cervical Spine) MRI (without contrast)
|
$1,293.45 |
$1,293.45 |
$1,293.45 |
$1,947.58
|
|
Neck MRA (blood vessel MRI, with and without contrast)
|
$2,892.85 |
$2,892.85 |
$2,892.85 |
$2,750.00
|
|
Neck MRA (blood vessel MRI, without contrast)
|
$1,895.65 |
$1,895.65 |
$1,895.65 |
$1,790.58
|
|
New Patient Office Visit (level 2)
|
$352.80 |
$352.80 |
$352.80 |
$178.00
|
|
New Patient Office Visit (level 3)
|
$352.80 |
$352.80 |
$352.80 |
$229.20
|
|
New Patient Office Visit (level 4)
|
$445.65 |
$445.65 |
$445.65 |
$307.00
|
|
New Patient Office Visit (level 5)
|
$551.30 |
$551.30 |
$551.30 |
$401.50
|
|
Nuclear Stress Test (Heart)
|
$3,200.40 |
$3,200.40 |
$3,200.40 |
$3,799.90
|
|
PSA (Prostate) Test
|
$128.25 |
$128.25 |
$128.25 |
$103.85
|
|
Pelvic CT scan (with and without contrast)
|
$1,495.15 |
$1,495.15 |
$1,495.15 |
$1,992.00
|
|
Pelvic CT scan (with contrast)
|
$1,297.60 |
$1,297.60 |
$1,297.60 |
$1,706.25
|
|
Pelvic CT scan (without contrast)
|
$839.25 |
$839.25 |
$839.25 |
$1,366.50
|
|
Pelvic MRI (with and without contrast)
|
$2,451.45 |
$2,451.45 |
$2,451.45 |
$2,713.80
|
|
Pelvic MRI (without contrast)
|
$1,822.25 |
$1,822.25 |
$1,822.25 |
$1,810.38
|
|
Pelvic Ultrasound (complete)
|
$924.60 |
$924.60 |
$924.60 |
$647.87
|
|
Pelvic Ultrasound (limited)
|
$568.40 |
$568.40 |
$568.40 |
$476.50
|
|
Pregnancy Ultrasound (complete, after first trimester)
|
$924.60 |
$924.60 |
$924.60 |
$607.12
|
|
Pregnancy Ultrasound (first trimester)
|
$701.40 |
$701.40 |
$701.40 |
$592.15
|
|
Rapid Strep Test
|
$49.15 |
$49.15 |
$49.15 |
$72.00
|
|
Screening Mammogram
|
$354.90 |
$354.90 |
$354.90 |
$331.50
|
|
Shoulder MRI (with and without contrast)
|
$2,708.00 |
$2,708.00 |
$2,708.00 |
$2,650.10
|
|
Shoulder MRI (with contrast)
|
$2,183.30 |
$2,183.30 |
$2,183.30 |
$2,822.25
|
|
Shoulder MRI (without contrast)
|
$1,366.70 |
$1,366.70 |
$1,366.70 |
$1,938.28
|
|
Shoulder X-ray
|
$220.70 |
$220.70 |
$220.70 |
$307.20
|
|
Sinus CT scan (with and without contrast)
|
$2,649.25 |
$2,649.25 |
$2,649.25 |
$1,871.00
|
|
Sinus CT scan (with contrast)
|
$963.40 |
$963.40 |
$963.40 |
$1,566.40
|
|
Sinus CT scan (without contrast)
|
$799.75 |
$799.75 |
$799.75 |
$1,275.30
|
|
Sleep Study (Polysomnography)
|
$3,312.90 |
$3,312.90 |
$3,312.90 |
$4,141.16
|
|
Thyroid (TSH) Test
|
$214.55 |
$214.55 |
$214.55 |
$110.00
|
|
Thyroid Ultrasound
|
$634.90 |
$634.90 |
$634.90 |
$603.90
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,191.75 |
$2,191.75 |
$2,191.75 |
$2,713.80
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,864.50 |
$1,864.50 |
$1,864.50 |
$2,039.85
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,296.25 |
$1,296.25 |
$1,296.25 |
$2,013.08
|
|
Urinalysis (with microscopy)
|
$150.20 |
$150.20 |
$150.20 |
$36.52
|
|
Urinalysis (without microscopy)
|
$59.35 |
$59.35 |
$59.35 |
$32.50
|
|
Urine Culture Test
|
$120.00 |
$120.00 |
$120.00 |
$65.25
|
|
Vitamin D Test
|
$167.40 |
$167.40 |
$167.40 |
$145.80
|
|
Wrist X-ray
|
$266.20 |
$266.20 |
$266.20 |
$311.20
|