|
Abdominal CT scan (with and without contrast)
|
$969.00 |
$969.00 |
$969.00 |
$2,049.00
|
|
Abdominal CT scan (with contrast)
|
$754.20 |
$754.20 |
$754.20 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$590.40 |
$590.40 |
$590.40 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$1,915.20 |
$1,915.20 |
$1,915.20 |
$3,061.80
|
|
Abdominal MRI (with contrast)
|
$1,393.80 |
$1,393.80 |
$1,393.80 |
$2,096.25
|
|
Abdominal MRI (without contrast)
|
$1,335.60 |
$1,335.60 |
$1,335.60 |
$1,902.00
|
|
Abdominal Ultrasound (complete)
|
$439.20 |
$439.20 |
$439.20 |
$755.00
|
|
Abdominal Ultrasound (limited)
|
$280.80 |
$280.80 |
$280.80 |
$629.42
|
|
Ankle X-ray
|
$140.40 |
$140.40 |
$140.40 |
$312.74
|
|
Appendix Removal (Laparoscopic)
|
$805.20 |
$805.20 |
$805.20 |
$6,457.82
|
|
Blood Clotting (PT/INR) Test
|
$30.60 |
$30.60 |
$30.60 |
$45.00
|
|
Blood Clotting (PTT) Test
|
$44.40 |
$44.40 |
$44.40 |
$64.35
|
|
Blood Count (CBC) Test
|
$42.60 |
$42.60 |
$42.60 |
$66.75
|
|
Blood Count (CBC) Test (without differential)
|
$46.80 |
$46.80 |
$46.80 |
$57.50
|
|
Blood Culture Test
|
$73.80 |
$73.80 |
$73.80 |
$112.20
|
|
Bone Density Scan (DEXA)
|
$351.60 |
$351.60 |
$351.60 |
$398.56
|
|
Brain MRA (blood vessel MRI, with and without contrast)
|
$2,076.00 |
$2,076.00 |
$2,076.00 |
$2,650.00
|
|
Brain MRA (blood vessel MRI, with contrast)
|
$1,384.20 |
$1,384.20 |
$1,384.20 |
$1,998.00
|
|
Brain MRA (blood vessel MRI, without contrast)
|
$1,230.00 |
$1,230.00 |
$1,230.00 |
$1,802.40
|
|
Brain MRI (with and without contrast)
|
$1,909.80 |
$1,909.80 |
$1,909.80 |
$2,919.75
|
|
Brain MRI (with contrast)
|
$1,243.20 |
$1,243.20 |
$1,243.20 |
$2,224.96
|
|
Brain MRI (without contrast)
|
$977.40 |
$977.40 |
$977.40 |
$1,830.00
|
|
Breast Biopsy (ultrasound-guided, percutaneous)
|
$419.40 |
$419.40 |
$419.40 |
$3,069.25
|
|
CT Angiogram of Abdomen and Pelvis
|
$1,027.20 |
$1,027.20 |
$1,027.20 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$1,119.60 |
$1,119.60 |
$1,119.60 |
$2,094.23
|
|
CT Angiogram of the Head
|
$999.00 |
$999.00 |
$999.00 |
$2,094.23
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$1,848.00 |
$1,848.00 |
$1,848.00 |
$3,669.25
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$1,431.00 |
$1,431.00 |
$1,431.00 |
$3,217.18
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,185.60 |
$1,185.60 |
$1,185.60 |
$2,418.75
|
|
Cardiac Stress Test
|
$233.40 |
$233.40 |
$233.40 |
$186.60
|
|
Carotid Artery Ultrasound (Duplex)
|
$481.20 |
$481.20 |
$481.20 |
$1,059.82
|
|
Carpal Tunnel Release Surgery
|
$763.80 |
$763.80 |
$763.80 |
$3,503.75
|
|
Chest CT scan (with and without contrast)
|
$1,992.60 |
$1,992.60 |
$1,992.60 |
$2,105.40
|
|
Chest CT scan (with contrast)
|
$1,725.00 |
$1,725.00 |
$1,725.00 |
$1,697.25
|
|
Chest CT scan (without contrast)
|
$751.80 |
$751.80 |
$751.80 |
$1,350.03
|
|
Chest X-ray
|
$150.60 |
$150.60 |
$150.60 |
$303.24
|
|
Chest X-ray (single view)
|
$102.60 |
$102.60 |
$102.60 |
$225.00
|
|
Cholesterol (Lipid) Test
|
$97.80 |
$97.80 |
$97.80 |
$100.00
|
|
Circumcision (newborn)
|
$283.80 |
$283.80 |
$283.80 |
$1,549.50
|
|
Colonoscopy (diagnostic)
|
$609.00 |
$609.00 |
$609.00 |
$1,500.00
|
|
Colonoscopy (with biopsy)
|
$727.20 |
$727.20 |
$727.20 |
$1,846.40
|
|
Colonoscopy (with polyp removal)
|
$862.80 |
$862.80 |
$862.80 |
$1,875.00
|
|
Cystoscopy (Bladder Scope)
|
$400.80 |
$400.80 |
$400.80 |
$1,636.00
|
|
Diabetes (HbA1c) Test
|
$75.00 |
$75.00 |
$75.00 |
$70.00
|
|
Diagnostic Mammogram (both breasts)
|
$458.40 |
$458.40 |
$458.40 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$360.00 |
$360.00 |
$360.00 |
$297.05
|
|
EKG (Electrocardiogram)
|
$154.20 |
$154.20 |
$154.20 |
$140.07
|
|
ER Visit (level 1, minor)
|
$136.20 |
$136.20 |
$136.20 |
$286.51
|
|
ER Visit (level 2)
|
$210.00 |
$210.00 |
$210.00 |
$469.39
|
|
ER Visit (level 3)
|
$274.20 |
$274.20 |
$274.20 |
$827.20
|
|
ER Visit (level 4)
|
$357.00 |
$357.00 |
$357.00 |
$1,330.00
|
|
ER Visit (level 5, high severity)
|
$630.00 |
$630.00 |
$630.00 |
$1,892.80
|
|
Echocardiogram (Heart Ultrasound)
|
$837.00 |
$837.00 |
$837.00 |
$2,021.12
|
|
Established Patient Office Visit (level 1)
|
$84.00 |
$84.00 |
$84.00 |
$115.05
|
|
Established Patient Office Visit (level 2)
|
$110.40 |
$110.40 |
$110.40 |
$127.53
|
|
Established Patient Office Visit (level 3)
|
$183.00 |
$183.00 |
$183.00 |
$183.60
|
|
Established Patient Office Visit (level 4)
|
$273.00 |
$273.00 |
$273.00 |
$228.60
|
|
Established Patient Office Visit (level 5)
|
$367.80 |
$367.80 |
$367.80 |
$306.40
|
|
Flexible Sigmoidoscopy
|
$176.40 |
$176.40 |
$176.40 |
$1,278.72
|
|
Foot X-ray
|
$144.60 |
$144.60 |
$144.60 |
$339.50
|
|
Gallbladder Removal (Laparoscopic)
|
$1,009.80 |
$1,009.80 |
$1,009.80 |
$6,672.53
|
|
Hand X-ray
|
$140.40 |
$140.40 |
$140.40 |
$315.00
|
|
Head CT scan (with and without contrast)
|
$1,671.60 |
$1,671.60 |
$1,671.60 |
$1,914.25
|
|
Head CT scan (with contrast)
|
$1,234.80 |
$1,234.80 |
$1,234.80 |
$1,587.69
|
|
Head CT scan (without contrast)
|
$753.00 |
$753.00 |
$753.00 |
$1,268.90
|
|
Hernia Repair (Inguinal)
|
$918.00 |
$918.00 |
$918.00 |
$6,210.72
|
|
Hip X-ray
|
$148.80 |
$148.80 |
$148.80 |
$290.35
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$405.00 |
$405.00 |
$405.00 |
$683.50
|
|
Knee Arthroscopy (Cartilage Repair)
|
$1,536.60 |
$1,536.60 |
$1,536.60 |
$3,591.33
|
|
Knee Arthroscopy (Meniscus Repair)
|
$1,639.20 |
$1,639.20 |
$1,639.20 |
$3,705.22
|
|
Knee MRI (with and without contrast)
|
$1,857.00 |
$1,857.00 |
$1,857.00 |
$3,008.26
|
|
Knee MRI (with contrast)
|
$1,384.20 |
$1,384.20 |
$1,384.20 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$966.60 |
$966.60 |
$966.60 |
$2,209.22
|
|
Knee X-ray
|
$215.40 |
$215.40 |
$215.40 |
$387.20
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$495.00 |
$495.00 |
$495.00 |
$1,090.23
|
|
Liver Function Test
|
$79.20 |
$79.20 |
$79.20 |
$93.60
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$1,130.40 |
$1,130.40 |
$1,130.40 |
$1,909.80
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$961.20 |
$961.20 |
$961.20 |
$1,850.88
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$771.60 |
$771.60 |
$771.60 |
$1,517.10
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$1,907.40 |
$1,907.40 |
$1,907.40 |
$2,750.00
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$1,237.80 |
$1,237.80 |
$1,237.80 |
$2,415.68
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$1,032.00 |
$1,032.00 |
$1,032.00 |
$2,013.08
|
|
Lower Back (Lumbar Spine) X-ray
|
$171.00 |
$171.00 |
$171.00 |
$341.64
|
|
Lumbar Spinal Fusion (single level)
|
$2,020.20 |
$2,020.20 |
$2,020.20 |
$5,428.66
|
|
Lung Function Test (Spirometry)
|
$100.20 |
$100.20 |
$100.20 |
$296.91
|
|
Metabolic Blood Panel (Basic)
|
$81.60 |
$81.60 |
$81.60 |
$97.60
|
|
Metabolic Blood Panel (Comprehensive)
|
$100.80 |
$100.80 |
$100.80 |
$130.97
|
|
Neck (Cervical Spine) CT scan (with and without contrast)
|
$1,086.00 |
$1,086.00 |
$1,086.00 |
$1,992.00
|
|
Neck (Cervical Spine) CT scan (with contrast)
|
$1,012.80 |
$1,012.80 |
$1,012.80 |
$1,708.20
|
|
Neck (Cervical Spine) CT scan (without contrast)
|
$751.80 |
$751.80 |
$751.80 |
$1,513.95
|
|
Neck (Cervical Spine) MRI (with and without contrast)
|
$1,924.20 |
$1,924.20 |
$1,924.20 |
$2,750.00
|
|
Neck (Cervical Spine) MRI (with contrast)
|
$1,257.00 |
$1,257.00 |
$1,257.00 |
$2,231.16
|
|
Neck (Cervical Spine) MRI (without contrast)
|
$981.60 |
$981.60 |
$981.60 |
$1,947.58
|
|
Neck MRA (blood vessel MRI, with and without contrast)
|
$2,076.00 |
$2,076.00 |
$2,076.00 |
$2,750.00
|
|
Neck MRA (blood vessel MRI, with contrast)
|
$1,384.20 |
$1,384.20 |
$1,384.20 |
$2,030.23
|
|
Neck MRA (blood vessel MRI, without contrast)
|
$1,230.00 |
$1,230.00 |
$1,230.00 |
$1,790.58
|
|
New Patient Office Visit (level 2)
|
$183.00 |
$183.00 |
$183.00 |
$178.00
|
|
New Patient Office Visit (level 3)
|
$271.80 |
$271.80 |
$271.80 |
$229.20
|
|
New Patient Office Visit (level 4)
|
$420.00 |
$420.00 |
$420.00 |
$307.00
|
|
New Patient Office Visit (level 5)
|
$526.20 |
$526.20 |
$526.20 |
$401.50
|
|
Nuclear Stress Test (Heart)
|
$1,858.20 |
$1,858.20 |
$1,858.20 |
$3,799.90
|
|
PSA (Prostate) Test
|
$125.40 |
$125.40 |
$125.40 |
$103.85
|
|
Pelvic CT scan (with and without contrast)
|
$886.20 |
$886.20 |
$886.20 |
$1,992.00
|
|
Pelvic CT scan (with contrast)
|
$679.80 |
$679.80 |
$679.80 |
$1,706.25
|
|
Pelvic CT scan (without contrast)
|
$599.40 |
$599.40 |
$599.40 |
$1,366.50
|
|
Pelvic MRI (with and without contrast)
|
$1,912.20 |
$1,912.20 |
$1,912.20 |
$2,713.80
|
|
Pelvic MRI (with contrast)
|
$1,384.20 |
$1,384.20 |
$1,384.20 |
$1,966.42
|
|
Pelvic MRI (without contrast)
|
$1,230.00 |
$1,230.00 |
$1,230.00 |
$1,810.38
|
|
Pelvic Ultrasound (complete)
|
$316.80 |
$316.80 |
$316.80 |
$647.87
|
|
Pelvic Ultrasound (limited)
|
$280.20 |
$280.20 |
$280.20 |
$476.50
|
|
Pregnancy Ultrasound (complete, after first trimester)
|
$632.40 |
$632.40 |
$632.40 |
$607.12
|
|
Pregnancy Ultrasound (first trimester)
|
$445.80 |
$445.80 |
$445.80 |
$592.15
|
|
Rapid Strep Test
|
$59.40 |
$59.40 |
$59.40 |
$72.00
|
|
Screening Colonoscopy (average risk)
|
$633.00 |
$633.00 |
$633.00 |
$1,440.00
|
|
Screening Colonoscopy (high risk)
|
$718.20 |
$718.20 |
$718.20 |
$1,864.80
|
|
Screening Mammogram
|
$381.00 |
$381.00 |
$381.00 |
$331.50
|
|
Shoulder Arthroscopy (Rotator Cuff Repair)
|
$2,174.40 |
$2,174.40 |
$2,174.40 |
$5,272.00
|
|
Shoulder MRI (with and without contrast)
|
$1,855.20 |
$1,855.20 |
$1,855.20 |
$2,650.10
|
|
Shoulder MRI (with contrast)
|
$1,384.20 |
$1,384.20 |
$1,384.20 |
$2,822.25
|
|
Shoulder MRI (without contrast)
|
$966.00 |
$966.00 |
$966.00 |
$1,938.28
|
|
Shoulder X-ray
|
$144.60 |
$144.60 |
$144.60 |
$307.20
|
|
Sinus CT scan (with and without contrast)
|
$1,477.80 |
$1,477.80 |
$1,477.80 |
$1,871.00
|
|
Sinus CT scan (with contrast)
|
$1,350.00 |
$1,350.00 |
$1,350.00 |
$1,566.40
|
|
Sinus CT scan (without contrast)
|
$1,144.80 |
$1,144.80 |
$1,144.80 |
$1,275.30
|
|
Skin Biopsy
|
$357.60 |
$357.60 |
$357.60 |
$381.60
|
|
Thyroid (TSH) Test
|
$78.60 |
$78.60 |
$78.60 |
$110.00
|
|
Thyroid Ultrasound
|
$339.60 |
$339.60 |
$339.60 |
$603.90
|
|
Tonsillectomy (age 12+)
|
$461.40 |
$461.40 |
$461.40 |
$1,308.80
|
|
Total Hip Replacement
|
$3,477.00 |
$3,477.00 |
$3,477.00 |
$6,675.20
|
|
Total Knee Replacement
|
$3,271.80 |
$3,271.80 |
$3,271.80 |
$6,668.80
|
|
Tubal Ligation (Laparoscopic)
|
$678.00 |
$678.00 |
$678.00 |
$1,536.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,926.00 |
$1,926.00 |
$1,926.00 |
$2,713.80
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,250.40 |
$1,250.40 |
$1,250.40 |
$2,039.85
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,042.20 |
$1,042.20 |
$1,042.20 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$878.40 |
$878.40 |
$878.40 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$637.20 |
$637.20 |
$637.20 |
$1,675.80
|
|
Urinalysis (with microscopy)
|
$34.20 |
$34.20 |
$34.20 |
$36.52
|
|
Urinalysis (without microscopy)
|
$19.20 |
$19.20 |
$19.20 |
$32.50
|
|
Urine Culture Test
|
$57.60 |
$57.60 |
$57.60 |
$65.25
|
|
Vasectomy
|
$1,078.20 |
$1,078.20 |
$1,078.20 |
$2,361.00
|
|
Vitamin D Test
|
$147.00 |
$147.00 |
$147.00 |
$145.80
|
|
Wrist X-ray
|
$140.40 |
$140.40 |
$140.40 |
$311.20
|