|
Abdominal CT scan (with and without contrast)
|
$1,477.80 |
$1,477.80 |
$1,477.80 |
$2,049.00
|
|
Abdominal CT scan (with contrast)
|
$1,155.00 |
$1,155.00 |
$1,155.00 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$910.20 |
$910.20 |
$910.20 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$4,350.60 |
$4,350.60 |
$4,350.60 |
$3,061.80
|
|
Abdominal MRI (with contrast)
|
$2,653.80 |
$2,653.80 |
$2,653.80 |
$2,077.14
|
|
Abdominal MRI (without contrast)
|
$2,128.20 |
$2,128.20 |
$2,128.20 |
$1,902.00
|
|
Abdominal Ultrasound (complete)
|
$528.00 |
$528.00 |
$528.00 |
$755.00
|
|
Abdominal Ultrasound (limited)
|
$301.80 |
$301.80 |
$301.80 |
$629.42
|
|
Ankle X-ray
|
$202.80 |
$202.80 |
$202.80 |
$311.92
|
|
Blood Clotting (PT/INR) Test
|
$40.80 |
$40.80 |
$40.80 |
$45.00
|
|
Blood Clotting (PTT) Test
|
$40.80 |
$40.80 |
$40.80 |
$64.35
|
|
Blood Count (CBC) Test
|
$79.20 |
$79.20 |
$79.20 |
$66.75
|
|
Blood Count (CBC) Test (without differential)
|
$40.20 |
$40.20 |
$40.20 |
$56.55
|
|
Blood Culture Test
|
$56.40 |
$56.40 |
$56.40 |
$112.20
|
|
Bone Density Scan (DEXA)
|
$212.40 |
$212.40 |
$212.40 |
$398.56
|
|
Brain MRA (blood vessel MRI, with and without contrast)
|
$4,168.80 |
$4,168.80 |
$4,168.80 |
$2,604.00
|
|
Brain MRA (blood vessel MRI, with contrast)
|
$2,305.80 |
$2,305.80 |
$2,305.80 |
$1,998.00
|
|
Brain MRA (blood vessel MRI, without contrast)
|
$2,307.00 |
$2,307.00 |
$2,307.00 |
$1,790.00
|
|
Brain MRI (with and without contrast)
|
$2,954.40 |
$2,954.40 |
$2,954.40 |
$2,884.20
|
|
Brain MRI (with contrast)
|
$2,615.40 |
$2,615.40 |
$2,615.40 |
$2,224.96
|
|
Brain MRI (without contrast)
|
$2,244.60 |
$2,244.60 |
$2,244.60 |
$1,825.59
|
|
Breast Biopsy (ultrasound-guided, percutaneous)
|
$1,858.80 |
$1,858.80 |
$1,858.80 |
$3,069.25
|
|
CT Angiogram of Abdomen and Pelvis
|
$1,030.20 |
$1,030.20 |
$1,030.20 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$1,893.60 |
$1,893.60 |
$1,893.60 |
$2,094.23
|
|
CT Angiogram of the Head
|
$1,920.00 |
$1,920.00 |
$1,920.00 |
$2,094.23
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$822.60 |
$822.60 |
$822.60 |
$3,630.00
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$738.60 |
$738.60 |
$738.60 |
$3,180.75
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$477.00 |
$477.00 |
$477.00 |
$2,418.75
|
|
Carotid Artery Ultrasound (Duplex)
|
$1,056.60 |
$1,056.60 |
$1,056.60 |
$1,059.82
|
|
Carpal Tunnel Release Surgery
|
$1,610.40 |
$1,610.40 |
$1,610.40 |
$3,503.75
|
|
Chest CT scan (with and without contrast)
|
$1,448.40 |
$1,448.40 |
$1,448.40 |
$2,105.40
|
|
Chest CT scan (with contrast)
|
$1,153.20 |
$1,153.20 |
$1,153.20 |
$1,697.25
|
|
Chest CT scan (without contrast)
|
$954.00 |
$954.00 |
$954.00 |
$1,350.03
|
|
Chest X-ray
|
$247.20 |
$247.20 |
$247.20 |
$303.24
|
|
Chest X-ray (single view)
|
$178.80 |
$178.80 |
$178.80 |
$225.00
|
|
Cholesterol (Lipid) Test
|
$94.80 |
$94.80 |
$94.80 |
$100.00
|
|
Colonoscopy (diagnostic)
|
$746.40 |
$746.40 |
$746.40 |
$1,500.00
|
|
Colonoscopy (with biopsy)
|
$1,398.60 |
$1,398.60 |
$1,398.60 |
$1,846.40
|
|
Colonoscopy (with polyp removal)
|
$1,398.60 |
$1,398.60 |
$1,398.60 |
$1,875.00
|
|
Cystoscopy (Bladder Scope)
|
$1,731.00 |
$1,731.00 |
$1,731.00 |
$1,636.00
|
|
Diabetes (HbA1c) Test
|
$128.40 |
$128.40 |
$128.40 |
$69.55
|
|
Diagnostic Mammogram (both breasts)
|
$238.80 |
$238.80 |
$238.80 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$186.60 |
$186.60 |
$186.60 |
$297.05
|
|
ER Visit (level 1, minor)
|
$102.60 |
$102.60 |
$102.60 |
$286.51
|
|
ER Visit (level 2)
|
$151.20 |
$151.20 |
$151.20 |
$469.39
|
|
ER Visit (level 3)
|
$205.20 |
$205.20 |
$205.20 |
$827.20
|
|
ER Visit (level 4)
|
$312.60 |
$312.60 |
$312.60 |
$1,330.00
|
|
ER Visit (level 5, high severity)
|
$501.00 |
$501.00 |
$501.00 |
$1,892.80
|
|
Echocardiogram (Heart Ultrasound)
|
$1,049.40 |
$1,049.40 |
$1,049.40 |
$2,021.12
|
|
Established Patient Office Visit (level 1)
|
$72.60 |
$72.60 |
$72.60 |
$115.05
|
|
Established Patient Office Visit (level 2)
|
$79.20 |
$79.20 |
$79.20 |
$127.53
|
|
Established Patient Office Visit (level 3)
|
$79.20 |
$79.20 |
$79.20 |
$183.60
|
|
Established Patient Office Visit (level 4)
|
$134.40 |
$134.40 |
$134.40 |
$228.60
|
|
Established Patient Office Visit (level 5)
|
$130.80 |
$130.80 |
$130.80 |
$306.40
|
|
Foot X-ray
|
$355.20 |
$355.20 |
$355.20 |
$339.50
|
|
Hand X-ray
|
$307.20 |
$307.20 |
$307.20 |
$313.04
|
|
Head CT scan (with and without contrast)
|
$1,150.20 |
$1,150.20 |
$1,150.20 |
$1,881.36
|
|
Head CT scan (with contrast)
|
$927.00 |
$927.00 |
$927.00 |
$1,587.69
|
|
Head CT scan (without contrast)
|
$993.60 |
$993.60 |
$993.60 |
$1,268.90
|
|
Hip X-ray
|
$256.20 |
$256.20 |
$256.20 |
$290.00
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$528.00 |
$528.00 |
$528.00 |
$683.50
|
|
Knee MRI (with and without contrast)
|
$8,550.60 |
$8,550.60 |
$8,550.60 |
$3,008.26
|
|
Knee MRI (with contrast)
|
$5,051.40 |
$5,051.40 |
$5,051.40 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$4,363.20 |
$4,363.20 |
$4,363.20 |
$2,205.00
|
|
Knee X-ray
|
$278.40 |
$278.40 |
$278.40 |
$387.20
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,357.20 |
$1,357.20 |
$1,357.20 |
$1,090.23
|
|
Liver Function Test
|
$121.20 |
$121.20 |
$121.20 |
$92.85
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$1,447.20 |
$1,447.20 |
$1,447.20 |
$1,909.80
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$1,153.20 |
$1,153.20 |
$1,153.20 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$954.60 |
$954.60 |
$954.60 |
$1,517.10
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$4,383.00 |
$4,383.00 |
$4,383.00 |
$2,713.80
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$2,617.20 |
$2,617.20 |
$2,617.20 |
$2,415.68
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$2,338.80 |
$2,338.80 |
$2,338.80 |
$2,013.08
|
|
Lower Back (Lumbar Spine) X-ray
|
$138.00 |
$138.00 |
$138.00 |
$341.64
|
|
Lung Function Test (Spirometry)
|
$131.40 |
$131.40 |
$131.40 |
$296.91
|
|
Metabolic Blood Panel (Basic)
|
$132.00 |
$132.00 |
$132.00 |
$97.20
|
|
Metabolic Blood Panel (Comprehensive)
|
$169.80 |
$169.80 |
$169.80 |
$130.97
|
|
Neck (Cervical Spine) CT scan (with and without contrast)
|
$1,443.60 |
$1,443.60 |
$1,443.60 |
$1,992.00
|
|
Neck (Cervical Spine) CT scan (with contrast)
|
$1,227.60 |
$1,227.60 |
$1,227.60 |
$1,708.20
|
|
Neck (Cervical Spine) CT scan (without contrast)
|
$954.60 |
$954.60 |
$954.60 |
$1,513.95
|
|
Neck (Cervical Spine) MRI (with and without contrast)
|
$4,383.00 |
$4,383.00 |
$4,383.00 |
$2,750.00
|
|
Neck (Cervical Spine) MRI (with contrast)
|
$2,615.40 |
$2,615.40 |
$2,615.40 |
$2,231.16
|
|
Neck (Cervical Spine) MRI (without contrast)
|
$2,157.60 |
$2,157.60 |
$2,157.60 |
$1,914.00
|
|
Neck MRA (blood vessel MRI, with and without contrast)
|
$4,165.80 |
$4,165.80 |
$4,165.80 |
$2,733.00
|
|
Neck MRA (blood vessel MRI, with contrast)
|
$2,343.00 |
$2,343.00 |
$2,343.00 |
$2,030.23
|
|
Neck MRA (blood vessel MRI, without contrast)
|
$2,307.00 |
$2,307.00 |
$2,307.00 |
$1,790.58
|
|
New Patient Office Visit (level 2)
|
$79.20 |
$79.20 |
$79.20 |
$178.00
|
|
New Patient Office Visit (level 3)
|
$103.20 |
$103.20 |
$103.20 |
$229.20
|
|
New Patient Office Visit (level 4)
|
$130.20 |
$130.20 |
$130.20 |
$307.00
|
|
New Patient Office Visit (level 5)
|
$190.80 |
$190.80 |
$190.80 |
$401.50
|
|
Nuclear Stress Test (Heart)
|
$1,626.00 |
$1,626.00 |
$1,626.00 |
$3,799.90
|
|
PSA (Prostate) Test
|
$70.20 |
$70.20 |
$70.20 |
$103.85
|
|
Pelvic CT scan (with and without contrast)
|
$1,403.40 |
$1,403.40 |
$1,403.40 |
$1,992.00
|
|
Pelvic CT scan (with contrast)
|
$1,190.40 |
$1,190.40 |
$1,190.40 |
$1,680.60
|
|
Pelvic CT scan (without contrast)
|
$939.00 |
$939.00 |
$939.00 |
$1,313.40
|
|
Pelvic MRI (with and without contrast)
|
$4,349.40 |
$4,349.40 |
$4,349.40 |
$2,713.80
|
|
Pelvic MRI (with contrast)
|
$2,572.20 |
$2,572.20 |
$2,572.20 |
$1,966.42
|
|
Pelvic MRI (without contrast)
|
$2,212.80 |
$2,212.80 |
$2,212.80 |
$1,810.38
|
|
Pelvic Ultrasound (complete)
|
$353.40 |
$353.40 |
$353.40 |
$647.87
|
|
Pelvic Ultrasound (limited)
|
$348.60 |
$348.60 |
$348.60 |
$476.50
|
|
Pregnancy Ultrasound (complete, after first trimester)
|
$491.40 |
$491.40 |
$491.40 |
$607.12
|
|
Pregnancy Ultrasound (first trimester)
|
$403.80 |
$403.80 |
$403.80 |
$580.03
|
|
Rapid Strep Test
|
$60.60 |
$60.60 |
$60.60 |
$72.00
|
|
Screening Mammogram
|
$174.60 |
$174.60 |
$174.60 |
$331.50
|
|
Shoulder MRI (with and without contrast)
|
$8,550.60 |
$8,550.60 |
$8,550.60 |
$2,650.10
|
|
Shoulder MRI (with contrast)
|
$5,029.20 |
$5,029.20 |
$5,029.20 |
$2,769.75
|
|
Shoulder MRI (without contrast)
|
$4,336.80 |
$4,336.80 |
$4,336.80 |
$1,938.28
|
|
Shoulder X-ray
|
$307.20 |
$307.20 |
$307.20 |
$306.88
|
|
Sinus CT scan (with and without contrast)
|
$1,102.80 |
$1,102.80 |
$1,102.80 |
$1,871.00
|
|
Sinus CT scan (with contrast)
|
$993.60 |
$993.60 |
$993.60 |
$1,566.40
|
|
Sinus CT scan (without contrast)
|
$820.20 |
$820.20 |
$820.20 |
$1,275.30
|
|
Skin Biopsy
|
$98.40 |
$98.40 |
$98.40 |
$378.65
|
|
Thyroid (TSH) Test
|
$108.00 |
$108.00 |
$108.00 |
$110.00
|
|
Thyroid Ultrasound
|
$308.40 |
$308.40 |
$308.40 |
$603.90
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,313.40 |
$4,313.40 |
$4,313.40 |
$2,713.80
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,526.00 |
$2,526.00 |
$2,526.00 |
$2,039.85
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,338.80 |
$2,338.80 |
$2,338.80 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$903.00 |
$903.00 |
$903.00 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,346.40 |
$1,346.40 |
$1,346.40 |
$1,675.80
|
|
Urinalysis (with microscopy)
|
$100.80 |
$100.80 |
$100.80 |
$36.52
|
|
Urinalysis (without microscopy)
|
$80.40 |
$80.40 |
$80.40 |
$32.50
|
|
Urine Culture Test
|
$140.40 |
$140.40 |
$140.40 |
$65.15
|
|
Vasectomy
|
$2,741.40 |
$2,741.40 |
$2,741.40 |
$2,361.00
|
|
Vitamin D Test
|
$160.20 |
$160.20 |
$160.20 |
$142.35
|
|
Wrist X-ray
|
$307.20 |
$307.20 |
$307.20 |
$311.17
|