|
Abdominal CT scan (with and without contrast)
|
$241.18 |
$241.18 |
$241.18 |
$2,049.00
|
|
Abdominal CT scan (with contrast)
|
$241.18 |
$241.18 |
$241.18 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$143.75 |
$143.75 |
$143.75 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$479.72 |
$479.72 |
$479.72 |
$3,061.80
|
|
Abdominal MRI (with contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,077.14
|
|
Abdominal MRI (without contrast)
|
$328.08 |
$328.08 |
$328.08 |
$1,902.00
|
|
Abdominal Ultrasound (complete)
|
$143.75 |
$143.75 |
$143.75 |
$755.00
|
|
Abdominal Ultrasound (limited)
|
$143.75 |
$143.75 |
$143.75 |
$629.42
|
|
Allergy Skin Testing
|
$1,180.80 |
$1,180.80 |
$1,180.80 |
$47.44
|
|
Ankle X-ray
|
$119.66 |
$119.66 |
$119.66 |
$312.74
|
|
Annual Physical, Established Patient (age 18-39)
|
$137.00 |
$137.00 |
$137.00 |
$203.45
|
|
Annual Physical, Established Patient (age 40-64)
|
$147.00 |
$147.00 |
$147.00 |
$212.88
|
|
Annual Physical, New Patient (age 18-39)
|
$154.00 |
$154.00 |
$154.00 |
$218.00
|
|
Annual Physical, New Patient (age 40-64)
|
$172.00 |
$172.00 |
$172.00 |
$229.20
|
|
Appendix Removal (Laparoscopic)
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
$6,457.82
|
|
Blood Clotting (PT/INR) Test
|
$5.92 |
$5.92 |
$5.92 |
$45.00
|
|
Blood Clotting (PTT) Test
|
$8.29 |
$8.29 |
$8.29 |
$65.00
|
|
Blood Count (CBC) Test
|
$10.72 |
$10.72 |
$10.72 |
$66.60
|
|
Blood Count (CBC) Test (without differential)
|
$8.93 |
$8.93 |
$8.93 |
$56.55
|
|
Blood Culture Test
|
$14.24 |
$14.24 |
$14.24 |
$112.20
|
|
Bone Density Scan (DEXA)
|
$143.75 |
$143.75 |
$143.75 |
$398.56
|
|
Brain MRA (blood vessel MRI, with and without contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,604.00
|
|
Brain MRA (blood vessel MRI, with contrast)
|
$479.72 |
$479.72 |
$479.72 |
$1,998.00
|
|
Brain MRA (blood vessel MRI, without contrast)
|
$328.08 |
$328.08 |
$328.08 |
$1,790.00
|
|
Brain MRI (with and without contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,884.20
|
|
Brain MRI (with contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,224.96
|
|
Brain MRI (without contrast)
|
$328.08 |
$328.08 |
$328.08 |
$1,825.59
|
|
Breast Biopsy (ultrasound-guided, percutaneous)
|
$2,271.01 |
$2,271.01 |
$2,271.01 |
$3,092.06
|
|
C-Section Delivery (full care)
|
$3,792.01 |
$3,792.01 |
$3,792.01 |
$4,739.20
|
|
CT Angiogram of Abdomen and Pelvis
|
$479.72 |
$479.72 |
$479.72 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$241.18 |
$241.18 |
$241.18 |
$2,094.23
|
|
CT Angiogram of the Head
|
$241.18 |
$241.18 |
$241.18 |
$2,094.23
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$479.72 |
$479.72 |
$479.72 |
$3,669.25
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$479.72 |
$479.72 |
$479.72 |
$3,217.18
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$328.08 |
$328.08 |
$328.08 |
$2,418.75
|
|
Cardiac Stress Test
|
$100.37 |
$100.37 |
$100.37 |
$186.60
|
|
Carotid Artery Ultrasound (Duplex)
|
$328.08 |
$328.08 |
$328.08 |
$1,059.82
|
|
Carpal Tunnel Release Surgery
|
$2,685.07 |
$2,685.07 |
$2,685.07 |
$3,503.75
|
|
Cataract Surgery
|
$3,173.34 |
$3,173.34 |
$3,173.34 |
$2,715.20
|
|
Chest CT scan (with and without contrast)
|
$241.18 |
$241.18 |
$241.18 |
$2,105.40
|
|
Chest CT scan (with contrast)
|
$241.18 |
$241.18 |
$241.18 |
$1,697.25
|
|
Chest CT scan (without contrast)
|
$143.75 |
$143.75 |
$143.75 |
$1,350.03
|
|
Chest X-ray
|
$119.66 |
$119.66 |
$119.66 |
$303.24
|
|
Chest X-ray (single view)
|
$119.66 |
$119.66 |
$119.66 |
$225.00
|
|
Cholesterol (Lipid) Test
|
$18.48 |
$18.48 |
$18.48 |
$100.00
|
|
Circumcision (newborn)
|
$2,874.36 |
$2,874.36 |
$2,874.36 |
$1,549.50
|
|
Colonoscopy (diagnostic)
|
$1,278.72 |
$1,278.72 |
$1,278.72 |
$1,500.00
|
|
Colonoscopy (with biopsy)
|
$1,645.43 |
$1,645.43 |
$1,645.43 |
$1,846.40
|
|
Colonoscopy (with polyp removal)
|
$1,645.43 |
$1,645.43 |
$1,645.43 |
$1,958.40
|
|
Cystoscopy (Bladder Scope)
|
$958.81 |
$958.81 |
$958.81 |
$1,636.00
|
|
Diabetes (HbA1c) Test
|
$38.00 |
$38.00 |
$38.00 |
$69.55
|
|
Diagnostic Mammogram (both breasts)
|
$147.89 |
$147.89 |
$147.89 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$115.09 |
$115.09 |
$115.09 |
$297.05
|
|
EKG (Electrocardiogram)
|
$21.40 |
$21.40 |
$21.40 |
$140.07
|
|
ER Visit (level 1, minor)
|
$115.95 |
$115.95 |
$115.95 |
$286.94
|
|
ER Visit (level 2)
|
$211.13 |
$211.13 |
$211.13 |
$469.39
|
|
ER Visit (level 3)
|
$375.36 |
$375.36 |
$375.36 |
$836.00
|
|
ER Visit (level 4)
|
$573.75 |
$573.75 |
$573.75 |
$1,330.12
|
|
ER Visit (level 5, high severity)
|
$818.88 |
$818.88 |
$818.88 |
$1,892.80
|
|
Echocardiogram (Heart Ultrasound)
|
$751.34 |
$751.34 |
$751.34 |
$2,024.64
|
|
Established Patient Office Visit (level 1)
|
$10.85 |
$10.85 |
$10.85 |
$115.05
|
|
Established Patient Office Visit (level 2)
|
$44.49 |
$44.49 |
$44.49 |
$127.53
|
|
Established Patient Office Visit (level 3)
|
$81.60 |
$81.60 |
$81.60 |
$183.60
|
|
Established Patient Office Visit (level 4)
|
$120.28 |
$120.28 |
$120.28 |
$228.60
|
|
Established Patient Office Visit (level 5)
|
$178.74 |
$178.74 |
$178.74 |
$306.40
|
|
Flexible Sigmoidoscopy
|
$1,278.72 |
$1,278.72 |
$1,278.72 |
$1,158.00
|
|
Foot X-ray
|
$119.66 |
$119.66 |
$119.66 |
$339.50
|
|
Gallbladder Removal (Laparoscopic)
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
$6,672.53
|
|
Hand X-ray
|
$119.66 |
$119.66 |
$119.66 |
$315.00
|
|
Head CT scan (with and without contrast)
|
$241.18 |
$241.18 |
$241.18 |
$1,914.25
|
|
Head CT scan (with contrast)
|
$241.18 |
$241.18 |
$241.18 |
$1,587.69
|
|
Head CT scan (without contrast)
|
$143.75 |
$143.75 |
$143.75 |
$1,268.90
|
|
Hernia Repair (Inguinal)
|
$4,923.19 |
$4,923.19 |
$4,923.19 |
$6,210.72
|
|
Hip X-ray
|
$119.66 |
$119.66 |
$119.66 |
$290.00
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$143.75 |
$143.75 |
$143.75 |
$683.50
|
|
Knee Arthroscopy (Cartilage Repair)
|
$4,499.12 |
$4,499.12 |
$4,499.12 |
$3,591.33
|
|
Knee Arthroscopy (Meniscus Repair)
|
$4,499.12 |
$4,499.12 |
$4,499.12 |
$3,705.22
|
|
Knee MRI (with and without contrast)
|
$479.72 |
$479.72 |
$479.72 |
$3,008.26
|
|
Knee MRI (with contrast)
|
$1,077.92 |
$1,077.92 |
$1,077.92 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$328.08 |
$328.08 |
$328.08 |
$2,205.00
|
|
Knee X-ray
|
$143.75 |
$143.75 |
$143.75 |
$388.44
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$328.08 |
$328.08 |
$328.08 |
$1,090.23
|
|
Liver Function Test
|
$11.27 |
$11.27 |
$11.27 |
$93.60
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$241.18 |
$241.18 |
$241.18 |
$1,909.80
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$479.72 |
$479.72 |
$479.72 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$143.75 |
$143.75 |
$143.75 |
$1,517.10
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,713.80
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,415.68
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$328.08 |
$328.08 |
$328.08 |
$2,013.08
|
|
Lower Back (Lumbar Spine) X-ray
|
$143.75 |
$143.75 |
$143.75 |
$341.64
|
|
Lumbar Spinal Fusion (single level)
|
$24,109.66 |
$24,109.66 |
$24,109.66 |
$5,428.66
|
|
Lung Function Test (Spirometry)
|
$296.91 |
$296.91 |
$296.91 |
$296.91
|
|
Metabolic Blood Panel (Basic)
|
$11.67 |
$11.67 |
$11.67 |
$97.60
|
|
Metabolic Blood Panel (Comprehensive)
|
$14.57 |
$14.57 |
$14.57 |
$135.20
|
|
Neck (Cervical Spine) CT scan (with and without contrast)
|
$241.18 |
$241.18 |
$241.18 |
$1,992.00
|
|
Neck (Cervical Spine) CT scan (with contrast)
|
$479.72 |
$479.72 |
$479.72 |
$1,708.20
|
|
Neck (Cervical Spine) CT scan (without contrast)
|
$143.75 |
$143.75 |
$143.75 |
$1,513.95
|
|
Neck (Cervical Spine) MRI (with and without contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,750.00
|
|
Neck (Cervical Spine) MRI (with contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,231.16
|
|
Neck (Cervical Spine) MRI (without contrast)
|
$328.08 |
$328.08 |
$328.08 |
$1,914.00
|
|
Neck MRA (blood vessel MRI, with and without contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,750.00
|
|
Neck MRA (blood vessel MRI, with contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,030.23
|
|
Neck MRA (blood vessel MRI, without contrast)
|
$328.08 |
$328.08 |
$328.08 |
$1,790.58
|
|
New Patient Office Visit (level 2)
|
$58.54 |
$58.54 |
$58.54 |
$178.00
|
|
New Patient Office Visit (level 3)
|
$103.09 |
$103.09 |
$103.09 |
$229.20
|
|
New Patient Office Visit (level 4)
|
$167.85 |
$167.85 |
$167.85 |
$307.00
|
|
New Patient Office Visit (level 5)
|
$231.11 |
$231.11 |
$231.11 |
$401.50
|
|
Nuclear Stress Test (Heart)
|
$1,780.19 |
$1,780.19 |
$1,780.19 |
$3,799.90
|
|
PSA (Prostate) Test
|
$25.38 |
$25.38 |
$25.38 |
$103.85
|
|
Pelvic CT scan (with and without contrast)
|
$241.18 |
$241.18 |
$241.18 |
$1,992.00
|
|
Pelvic CT scan (with contrast)
|
$241.18 |
$241.18 |
$241.18 |
$1,706.25
|
|
Pelvic CT scan (without contrast)
|
$143.75 |
$143.75 |
$143.75 |
$1,313.40
|
|
Pelvic MRI (with and without contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,713.80
|
|
Pelvic MRI (with contrast)
|
$479.72 |
$479.72 |
$479.72 |
$1,966.42
|
|
Pelvic MRI (without contrast)
|
$328.08 |
$328.08 |
$328.08 |
$1,810.38
|
|
Pelvic Ultrasound (complete)
|
$143.75 |
$143.75 |
$143.75 |
$647.87
|
|
Pelvic Ultrasound (limited)
|
$143.75 |
$143.75 |
$143.75 |
$476.50
|
|
Postpartum Care Only
|
$251.05 |
$251.05 |
$251.05 |
$501.60
|
|
Pregnancy Ultrasound (complete, after first trimester)
|
$143.75 |
$143.75 |
$143.75 |
$607.12
|
|
Pregnancy Ultrasound (first trimester)
|
$143.75 |
$143.75 |
$143.75 |
$580.03
|
|
Prenatal Care Only (4-6 visits)
|
$608.44 |
$608.44 |
$608.44 |
$1,136.00
|
|
Prenatal Care Only (7+ visits)
|
$1,116.09 |
$1,116.09 |
$1,116.09 |
$1,672.80
|
|
Rapid Strep Test
|
$22.81 |
$22.81 |
$22.81 |
$72.00
|
|
Screening Colonoscopy (average risk)
|
$1,278.72 |
$1,278.72 |
$1,278.72 |
$1,440.00
|
|
Screening Colonoscopy (high risk)
|
$1,278.72 |
$1,278.72 |
$1,278.72 |
$2,000.00
|
|
Screening Mammogram
|
$121.76 |
$121.76 |
$121.76 |
$331.50
|
|
Shoulder Arthroscopy (Rotator Cuff Repair)
|
$9,977.57 |
$9,977.57 |
$9,977.57 |
$5,272.00
|
|
Shoulder MRI (with and without contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,650.10
|
|
Shoulder MRI (with contrast)
|
$1,077.92 |
$1,077.92 |
$1,077.92 |
$2,822.25
|
|
Shoulder MRI (without contrast)
|
$328.08 |
$328.08 |
$328.08 |
$1,938.28
|
|
Shoulder X-ray
|
$119.66 |
$119.66 |
$119.66 |
$307.20
|
|
Sinus CT scan (with and without contrast)
|
$241.18 |
$241.18 |
$241.18 |
$1,871.00
|
|
Sinus CT scan (with contrast)
|
$241.18 |
$241.18 |
$241.18 |
$1,566.40
|
|
Sinus CT scan (without contrast)
|
$143.75 |
$143.75 |
$143.75 |
$1,275.30
|
|
Skin Biopsy
|
$558.97 |
$558.97 |
$558.97 |
$381.60
|
|
Sleep Study (Polysomnography)
|
$1,180.80 |
$1,180.80 |
$1,180.80 |
$4,141.16
|
|
Thyroid (TSH) Test
|
$23.18 |
$23.18 |
$23.18 |
$110.00
|
|
Thyroid Ultrasound
|
$143.75 |
$143.75 |
$143.75 |
$603.90
|
|
Tonsillectomy (age 12+)
|
$4,558.89 |
$4,558.89 |
$4,558.89 |
$1,308.80
|
|
Tonsillectomy (child under 12)
|
$8,139.99 |
$8,139.99 |
$8,139.99 |
$912.60
|
|
Total Hip Replacement
|
$17,653.66 |
$17,653.66 |
$17,653.66 |
$6,675.20
|
|
Total Knee Replacement
|
$17,653.66 |
$17,653.66 |
$17,653.66 |
$6,668.80
|
|
Tubal Ligation (Laparoscopic)
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
$1,536.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,713.80
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,039.85
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$328.08 |
$328.08 |
$328.08 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,247.13 |
$1,247.13 |
$1,247.13 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,247.13 |
$1,247.13 |
$1,247.13 |
$1,675.80
|
|
Urinalysis (with microscopy)
|
$4.37 |
$4.37 |
$4.37 |
$36.52
|
|
Urinalysis (without microscopy)
|
$3.11 |
$3.11 |
$3.11 |
$32.50
|
|
Urine Culture Test
|
$11.14 |
$11.14 |
$11.14 |
$65.15
|
|
Vaginal Delivery (full care)
|
$3,358.99 |
$3,358.99 |
$3,358.99 |
$4,552.00
|
|
Vasectomy
|
$2,874.36 |
$2,874.36 |
$2,874.36 |
$2,361.00
|
|
Vitamin D Test
|
$40.85 |
$40.85 |
$40.85 |
$142.35
|
|
Wrist X-ray
|
$119.66 |
$119.66 |
$119.66 |
$311.20
|