|
Abdominal CT scan (with and without contrast)
|
$1,424.40 |
$1,424.40 |
$1,424.40 |
$2,049.00
|
|
Abdominal CT scan (with contrast)
|
$1,424.40 |
$1,424.40 |
$1,424.40 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$876.00 |
$876.00 |
$876.00 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$3,061.80
|
|
Abdominal MRI (with contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$2,077.14
|
|
Abdominal MRI (without contrast)
|
$1,656.00 |
$1,656.00 |
$1,656.00 |
$1,902.00
|
|
Abdominal Ultrasound (complete)
|
$394.20 |
$394.20 |
$394.20 |
$755.00
|
|
Abdominal Ultrasound (limited)
|
$394.20 |
$394.20 |
$394.20 |
$629.42
|
|
Ankle X-ray
|
$188.40 |
$188.40 |
$188.40 |
$312.74
|
|
Blood Clotting (PT/INR) Test
|
$22.20 |
$22.20 |
$22.20 |
$45.00
|
|
Blood Clotting (PTT) Test
|
$30.60 |
$30.60 |
$30.60 |
$65.00
|
|
Blood Count (CBC) Test
|
$40.20 |
$40.20 |
$40.20 |
$67.20
|
|
Blood Count (CBC) Test (without differential)
|
$32.40 |
$32.40 |
$32.40 |
$56.55
|
|
Blood Culture Test
|
$57.00 |
$57.00 |
$57.00 |
$112.20
|
|
Bone Density Scan (DEXA)
|
$262.80 |
$262.80 |
$262.80 |
$398.56
|
|
Brain MRA (blood vessel MRI, with and without contrast)
|
$2,854.80 |
$2,854.80 |
$2,854.80 |
$2,604.00
|
|
Brain MRA (blood vessel MRI, with contrast)
|
$2,854.80 |
$2,854.80 |
$2,854.80 |
$1,998.00
|
|
Brain MRA (blood vessel MRI, without contrast)
|
$1,741.80 |
$1,741.80 |
$1,741.80 |
$1,790.00
|
|
Brain MRI (with and without contrast)
|
$2,854.80 |
$2,854.80 |
$2,854.80 |
$2,884.20
|
|
Brain MRI (with contrast)
|
$2,854.80 |
$2,854.80 |
$2,854.80 |
$2,224.96
|
|
Brain MRI (without contrast)
|
$1,741.80 |
$1,741.80 |
$1,741.80 |
$1,825.59
|
|
Breast Biopsy (ultrasound-guided, percutaneous)
|
$2,087.40 |
$2,087.40 |
$2,087.40 |
$3,092.06
|
|
C-Section Delivery (full care)
|
$10,034.40 |
$10,034.40 |
$10,034.40 |
$4,739.20
|
|
CT Angiogram of Abdomen and Pelvis
|
$2,985.60 |
$2,985.60 |
$2,985.60 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$1,424.40 |
$1,424.40 |
$1,424.40 |
$2,094.23
|
|
CT Angiogram of the Head
|
$1,294.80 |
$1,294.80 |
$1,294.80 |
$2,094.23
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$2,985.60 |
$2,985.60 |
$2,985.60 |
$3,669.25
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$2,985.60 |
$2,985.60 |
$2,985.60 |
$3,217.18
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,821.60 |
$1,821.60 |
$1,821.60 |
$2,418.75
|
|
Carotid Artery Ultrasound (Duplex)
|
$788.40 |
$788.40 |
$788.40 |
$1,059.82
|
|
Chest CT scan (with and without contrast)
|
$1,424.40 |
$1,424.40 |
$1,424.40 |
$2,105.40
|
|
Chest CT scan (with contrast)
|
$1,424.40 |
$1,424.40 |
$1,424.40 |
$1,697.25
|
|
Chest CT scan (without contrast)
|
$876.00 |
$876.00 |
$876.00 |
$1,350.03
|
|
Chest X-ray
|
$188.40 |
$188.40 |
$188.40 |
$303.24
|
|
Chest X-ray (single view)
|
$188.40 |
$188.40 |
$188.40 |
$225.00
|
|
Cholesterol (Lipid) Test
|
$87.60 |
$87.60 |
$87.60 |
$100.00
|
|
Circumcision (newborn)
|
$1,219.20 |
$1,219.20 |
$1,219.20 |
$1,549.50
|
|
Cystoscopy (Bladder Scope)
|
$1,815.60 |
$1,815.60 |
$1,815.60 |
$1,636.00
|
|
Diabetes (HbA1c) Test
|
$49.20 |
$49.20 |
$49.20 |
$69.55
|
|
Diagnostic Mammogram (both breasts)
|
$310.20 |
$310.20 |
$310.20 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$243.60 |
$243.60 |
$243.60 |
$297.05
|
|
ER Visit (level 1, minor)
|
$391.20 |
$391.20 |
$391.20 |
$286.94
|
|
ER Visit (level 2)
|
$570.60 |
$570.60 |
$570.60 |
$469.39
|
|
ER Visit (level 3)
|
$887.40 |
$887.40 |
$887.40 |
$836.00
|
|
ER Visit (level 4)
|
$1,320.00 |
$1,320.00 |
$1,320.00 |
$1,330.12
|
|
ER Visit (level 5, high severity)
|
$1,828.80 |
$1,828.80 |
$1,828.80 |
$1,892.80
|
|
Echocardiogram (Heart Ultrasound)
|
$2,311.20 |
$2,311.20 |
$2,311.20 |
$2,024.64
|
|
Flexible Sigmoidoscopy
|
$1,158.00 |
$1,158.00 |
$1,158.00 |
$1,158.00
|
|
Foot X-ray
|
$188.40 |
$188.40 |
$188.40 |
$339.50
|
|
Hand X-ray
|
$188.40 |
$188.40 |
$188.40 |
$315.00
|
|
Head CT scan (with and without contrast)
|
$1,294.80 |
$1,294.80 |
$1,294.80 |
$1,914.25
|
|
Head CT scan (with contrast)
|
$1,294.80 |
$1,294.80 |
$1,294.80 |
$1,587.69
|
|
Head CT scan (without contrast)
|
$796.80 |
$796.80 |
$796.80 |
$1,268.90
|
|
Hip X-ray
|
$188.40 |
$188.40 |
$188.40 |
$290.00
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$394.20 |
$394.20 |
$394.20 |
$683.50
|
|
Knee MRI (with and without contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$3,008.26
|
|
Knee MRI (with contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$1,656.00 |
$1,656.00 |
$1,656.00 |
$2,205.00
|
|
Knee X-ray
|
$262.80 |
$262.80 |
$262.80 |
$388.44
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$819.60 |
$819.60 |
$819.60 |
$1,090.23
|
|
Liver Function Test
|
$54.00 |
$54.00 |
$54.00 |
$93.60
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$1,424.40 |
$1,424.40 |
$1,424.40 |
$1,909.80
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$1,424.40 |
$1,424.40 |
$1,424.40 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$876.00 |
$876.00 |
$876.00 |
$1,517.10
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$2,713.80
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$2,415.68
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$1,656.00 |
$1,656.00 |
$1,656.00 |
$2,013.08
|
|
Lower Back (Lumbar Spine) X-ray
|
$262.80 |
$262.80 |
$262.80 |
$341.64
|
|
Lung Function Test (Spirometry)
|
$346.20 |
$346.20 |
$346.20 |
$296.91
|
|
Metabolic Blood Panel (Basic)
|
$55.20 |
$55.20 |
$55.20 |
$97.60
|
|
Metabolic Blood Panel (Comprehensive)
|
$68.40 |
$68.40 |
$68.40 |
$135.20
|
|
Neck (Cervical Spine) CT scan (with and without contrast)
|
$1,294.80 |
$1,294.80 |
$1,294.80 |
$1,992.00
|
|
Neck (Cervical Spine) CT scan (with contrast)
|
$1,294.80 |
$1,294.80 |
$1,294.80 |
$1,708.20
|
|
Neck (Cervical Spine) CT scan (without contrast)
|
$796.80 |
$796.80 |
$796.80 |
$1,513.95
|
|
Neck (Cervical Spine) MRI (with and without contrast)
|
$2,854.80 |
$2,854.80 |
$2,854.80 |
$2,750.00
|
|
Neck (Cervical Spine) MRI (with contrast)
|
$2,854.80 |
$2,854.80 |
$2,854.80 |
$2,231.16
|
|
Neck (Cervical Spine) MRI (without contrast)
|
$1,741.80 |
$1,741.80 |
$1,741.80 |
$1,914.00
|
|
Neck MRA (blood vessel MRI, with and without contrast)
|
$2,854.80 |
$2,854.80 |
$2,854.80 |
$2,750.00
|
|
Neck MRA (blood vessel MRI, with contrast)
|
$2,854.80 |
$2,854.80 |
$2,854.80 |
$2,030.23
|
|
Neck MRA (blood vessel MRI, without contrast)
|
$1,741.80 |
$1,741.80 |
$1,741.80 |
$1,790.58
|
|
Nuclear Stress Test (Heart)
|
$4,242.60 |
$4,242.60 |
$4,242.60 |
$3,842.40
|
|
PSA (Prostate) Test
|
$109.80 |
$109.80 |
$109.80 |
$103.85
|
|
Pelvic CT scan (with and without contrast)
|
$1,424.40 |
$1,424.40 |
$1,424.40 |
$1,992.00
|
|
Pelvic CT scan (with contrast)
|
$1,424.40 |
$1,424.40 |
$1,424.40 |
$1,706.25
|
|
Pelvic CT scan (without contrast)
|
$876.00 |
$876.00 |
$876.00 |
$1,313.40
|
|
Pelvic MRI (with and without contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$2,713.80
|
|
Pelvic MRI (with contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$1,966.42
|
|
Pelvic MRI (without contrast)
|
$1,656.00 |
$1,656.00 |
$1,656.00 |
$1,810.38
|
|
Pelvic Ultrasound (complete)
|
$394.20 |
$394.20 |
$394.20 |
$647.87
|
|
Pelvic Ultrasound (limited)
|
$394.20 |
$394.20 |
$394.20 |
$476.50
|
|
Pregnancy Ultrasound (complete, after first trimester)
|
$394.20 |
$394.20 |
$394.20 |
$607.12
|
|
Pregnancy Ultrasound (first trimester)
|
$394.20 |
$394.20 |
$394.20 |
$580.03
|
|
Rapid Strep Test
|
$93.00 |
$93.00 |
$93.00 |
$72.00
|
|
Screening Mammogram
|
$257.40 |
$257.40 |
$257.40 |
$331.50
|
|
Shoulder MRI (with and without contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$2,650.10
|
|
Shoulder MRI (with contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$2,822.25
|
|
Shoulder MRI (without contrast)
|
$1,656.00 |
$1,656.00 |
$1,656.00 |
$1,938.28
|
|
Shoulder X-ray
|
$188.40 |
$188.40 |
$188.40 |
$307.20
|
|
Sinus CT scan (with and without contrast)
|
$1,294.80 |
$1,294.80 |
$1,294.80 |
$1,871.00
|
|
Sinus CT scan (with contrast)
|
$1,294.80 |
$1,294.80 |
$1,294.80 |
$1,566.40
|
|
Sinus CT scan (without contrast)
|
$796.80 |
$796.80 |
$796.80 |
$1,275.30
|
|
Sleep Study (Polysomnography)
|
$4,279.20 |
$4,279.20 |
$4,279.20 |
$4,141.16
|
|
Thyroid (TSH) Test
|
$85.80 |
$85.80 |
$85.80 |
$110.00
|
|
Thyroid Ultrasound
|
$394.20 |
$394.20 |
$394.20 |
$603.90
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$2,713.80
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$2,039.85
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,656.00 |
$1,656.00 |
$1,656.00 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,509.00 |
$1,509.00 |
$1,509.00 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,019.60 |
$2,019.60 |
$2,019.60 |
$1,675.80
|
|
Urinalysis (with microscopy)
|
$23.40 |
$23.40 |
$23.40 |
$36.66
|
|
Urinalysis (without microscopy)
|
$17.40 |
$17.40 |
$17.40 |
$32.50
|
|
Urine Culture Test
|
$45.00 |
$45.00 |
$45.00 |
$65.15
|
|
Vitamin D Test
|
$149.40 |
$149.40 |
$149.40 |
$142.35
|
|
Wrist X-ray
|
$188.40 |
$188.40 |
$188.40 |
$311.20
|