|
Abdominal CT scan (with and without contrast)
|
$2,209.60 |
$2,209.60 |
$2,209.60 |
$2,049.00
|
|
Abdominal CT scan (with contrast)
|
$2,384.00 |
$2,384.00 |
$2,384.00 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$1,718.40 |
$1,718.40 |
$1,718.40 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$3,804.00 |
$3,804.00 |
$3,804.00 |
$3,061.80
|
|
Abdominal MRI (without contrast)
|
$2,850.40 |
$2,850.40 |
$2,850.40 |
$1,902.00
|
|
Abdominal Ultrasound (complete)
|
$934.40 |
$934.40 |
$934.40 |
$755.00
|
|
Abdominal Ultrasound (limited)
|
$720.80 |
$720.80 |
$720.80 |
$629.42
|
|
Ankle X-ray
|
$272.00 |
$272.00 |
$272.00 |
$311.92
|
|
Blood Clotting (PT/INR) Test
|
$33.60 |
$33.60 |
$33.60 |
$45.00
|
|
Blood Clotting (PTT) Test
|
$41.60 |
$41.60 |
$41.60 |
$64.35
|
|
Blood Count (CBC) Test
|
$42.40 |
$42.40 |
$42.40 |
$66.75
|
|
Blood Count (CBC) Test (without differential)
|
$32.00 |
$32.00 |
$32.00 |
$56.55
|
|
Blood Culture Test
|
$65.60 |
$65.60 |
$65.60 |
$112.20
|
|
Bone Density Scan (DEXA)
|
$472.80 |
$472.80 |
$472.80 |
$398.56
|
|
Brain MRA (blood vessel MRI, with and without contrast)
|
$3,671.20 |
$3,671.20 |
$3,671.20 |
$2,604.00
|
|
Brain MRA (blood vessel MRI, with contrast)
|
$2,993.60 |
$2,993.60 |
$2,993.60 |
$1,998.00
|
|
Brain MRA (blood vessel MRI, without contrast)
|
$2,637.60 |
$2,637.60 |
$2,637.60 |
$1,790.00
|
|
Brain MRI (with and without contrast)
|
$3,768.00 |
$3,768.00 |
$3,768.00 |
$2,884.20
|
|
Brain MRI (without contrast)
|
$2,649.60 |
$2,649.60 |
$2,649.60 |
$1,825.59
|
|
CT Angiogram of Abdomen and Pelvis
|
$3,712.00 |
$3,712.00 |
$3,712.00 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$2,650.40 |
$2,650.40 |
$2,650.40 |
$2,094.23
|
|
CT Angiogram of the Head
|
$2,454.40 |
$2,454.40 |
$2,454.40 |
$2,094.23
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$4,253.60 |
$4,253.60 |
$4,253.60 |
$3,630.00
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$3,592.00 |
$3,592.00 |
$3,592.00 |
$3,180.75
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,254.40 |
$3,254.40 |
$3,254.40 |
$2,418.75
|
|
Carotid Artery Ultrasound (Duplex)
|
$1,105.60 |
$1,105.60 |
$1,105.60 |
$1,059.82
|
|
Chest CT scan (with and without contrast)
|
$2,678.40 |
$2,678.40 |
$2,678.40 |
$2,105.40
|
|
Chest CT scan (with contrast)
|
$2,216.00 |
$2,216.00 |
$2,216.00 |
$1,697.25
|
|
Chest CT scan (without contrast)
|
$2,054.40 |
$2,054.40 |
$2,054.40 |
$1,350.03
|
|
Chest X-ray
|
$279.20 |
$279.20 |
$279.20 |
$303.24
|
|
Chest X-ray (single view)
|
$210.40 |
$210.40 |
$210.40 |
$225.00
|
|
Cholesterol (Lipid) Test
|
$75.20 |
$75.20 |
$75.20 |
$100.00
|
|
Diabetes (HbA1c) Test
|
$45.60 |
$45.60 |
$45.60 |
$69.55
|
|
ER Visit (level 1, minor)
|
$251.20 |
$251.20 |
$251.20 |
$286.51
|
|
ER Visit (level 2)
|
$494.40 |
$494.40 |
$494.40 |
$469.39
|
|
ER Visit (level 3)
|
$840.80 |
$840.80 |
$840.80 |
$827.20
|
|
ER Visit (level 4)
|
$1,288.80 |
$1,288.80 |
$1,288.80 |
$1,330.00
|
|
ER Visit (level 5, high severity)
|
$1,930.40 |
$1,930.40 |
$1,930.40 |
$1,892.80
|
|
Echocardiogram (Heart Ultrasound)
|
$2,140.80 |
$2,140.80 |
$2,140.80 |
$2,021.12
|
|
Established Patient Office Visit (level 1)
|
$160.00 |
$160.00 |
$160.00 |
$115.05
|
|
Established Patient Office Visit (level 2)
|
$105.60 |
$105.60 |
$105.60 |
$127.53
|
|
Established Patient Office Visit (level 3)
|
$131.20 |
$131.20 |
$131.20 |
$183.60
|
|
Established Patient Office Visit (level 4)
|
$158.40 |
$158.40 |
$158.40 |
$228.60
|
|
Foot X-ray
|
$252.00 |
$252.00 |
$252.00 |
$339.50
|
|
Hand X-ray
|
$252.00 |
$252.00 |
$252.00 |
$313.04
|
|
Head CT scan (with and without contrast)
|
$2,231.20 |
$2,231.20 |
$2,231.20 |
$1,881.36
|
|
Head CT scan (with contrast)
|
$2,008.00 |
$2,008.00 |
$2,008.00 |
$1,587.69
|
|
Head CT scan (without contrast)
|
$1,776.80 |
$1,776.80 |
$1,776.80 |
$1,268.90
|
|
Hip X-ray
|
$289.60 |
$289.60 |
$289.60 |
$290.00
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$778.40 |
$778.40 |
$778.40 |
$683.50
|
|
Knee MRI (with and without contrast)
|
$3,582.40 |
$3,582.40 |
$3,582.40 |
$3,008.26
|
|
Knee MRI (without contrast)
|
$2,696.00 |
$2,696.00 |
$2,696.00 |
$2,205.00
|
|
Knee X-ray
|
$384.00 |
$384.00 |
$384.00 |
$387.20
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,264.80 |
$1,264.80 |
$1,264.80 |
$1,090.23
|
|
Liver Function Test
|
$64.00 |
$64.00 |
$64.00 |
$92.85
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$2,199.20 |
$2,199.20 |
$2,199.20 |
$1,829.25
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$1,950.40 |
$1,950.40 |
$1,950.40 |
$1,517.10
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$3,938.40 |
$3,938.40 |
$3,938.40 |
$2,713.80
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$2,980.80 |
$2,980.80 |
$2,980.80 |
$2,013.08
|
|
Lower Back (Lumbar Spine) X-ray
|
$331.20 |
$331.20 |
$331.20 |
$341.64
|
|
Lung Function Test (Spirometry)
|
$427.20 |
$427.20 |
$427.20 |
$296.91
|
|
Metabolic Blood Panel (Basic)
|
$67.20 |
$67.20 |
$67.20 |
$97.20
|
|
Metabolic Blood Panel (Comprehensive)
|
$79.20 |
$79.20 |
$79.20 |
$130.97
|
|
Neck (Cervical Spine) CT scan (with contrast)
|
$2,361.60 |
$2,361.60 |
$2,361.60 |
$1,708.20
|
|
Neck (Cervical Spine) CT scan (without contrast)
|
$1,997.60 |
$1,997.60 |
$1,997.60 |
$1,513.95
|
|
Neck (Cervical Spine) MRI (with and without contrast)
|
$4,217.60 |
$4,217.60 |
$4,217.60 |
$2,750.00
|
|
Neck (Cervical Spine) MRI (without contrast)
|
$2,884.80 |
$2,884.80 |
$2,884.80 |
$1,914.00
|
|
Neck MRA (blood vessel MRI, with and without contrast)
|
$3,511.20 |
$3,511.20 |
$3,511.20 |
$2,733.00
|
|
Neck MRA (blood vessel MRI, with contrast)
|
$2,823.20 |
$2,823.20 |
$2,823.20 |
$2,030.23
|
|
Neck MRA (blood vessel MRI, without contrast)
|
$2,470.40 |
$2,470.40 |
$2,470.40 |
$1,790.58
|
|
Nuclear Stress Test (Heart)
|
$4,260.80 |
$4,260.80 |
$4,260.80 |
$3,799.90
|
|
PSA (Prostate) Test
|
$89.60 |
$89.60 |
$89.60 |
$103.85
|
|
Pelvic CT scan (with and without contrast)
|
$2,004.00 |
$2,004.00 |
$2,004.00 |
$1,992.00
|
|
Pelvic CT scan (with contrast)
|
$1,929.60 |
$1,929.60 |
$1,929.60 |
$1,680.60
|
|
Pelvic CT scan (without contrast)
|
$1,815.20 |
$1,815.20 |
$1,815.20 |
$1,313.40
|
|
Pelvic MRI (with and without contrast)
|
$3,956.80 |
$3,956.80 |
$3,956.80 |
$2,713.80
|
|
Pelvic MRI (without contrast)
|
$2,768.80 |
$2,768.80 |
$2,768.80 |
$1,810.38
|
|
Pelvic Ultrasound (complete)
|
$779.20 |
$779.20 |
$779.20 |
$647.87
|
|
Pelvic Ultrasound (limited)
|
$638.40 |
$638.40 |
$638.40 |
$476.50
|
|
Pregnancy Ultrasound (complete, after first trimester)
|
$794.40 |
$794.40 |
$794.40 |
$607.12
|
|
Pregnancy Ultrasound (first trimester)
|
$721.60 |
$721.60 |
$721.60 |
$580.03
|
|
Rapid Strep Test
|
$48.00 |
$48.00 |
$48.00 |
$72.00
|
|
Screening Mammogram
|
$416.80 |
$416.80 |
$416.80 |
$331.50
|
|
Shoulder MRI (with and without contrast)
|
$3,819.20 |
$3,819.20 |
$3,819.20 |
$2,650.10
|
|
Shoulder MRI (without contrast)
|
$2,675.20 |
$2,675.20 |
$2,675.20 |
$1,938.28
|
|
Shoulder X-ray
|
$320.80 |
$320.80 |
$320.80 |
$306.88
|
|
Sinus CT scan (with and without contrast)
|
$2,388.00 |
$2,388.00 |
$2,388.00 |
$1,871.00
|
|
Sinus CT scan (with contrast)
|
$2,045.60 |
$2,045.60 |
$2,045.60 |
$1,566.40
|
|
Sinus CT scan (without contrast)
|
$1,618.40 |
$1,618.40 |
$1,618.40 |
$1,275.30
|
|
Sleep Study (Polysomnography)
|
$3,947.20 |
$3,947.20 |
$3,947.20 |
$4,141.16
|
|
Thyroid (TSH) Test
|
$81.60 |
$81.60 |
$81.60 |
$110.00
|
|
Thyroid Ultrasound
|
$680.00 |
$680.00 |
$680.00 |
$603.90
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,056.00 |
$4,056.00 |
$4,056.00 |
$2,713.80
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,735.20 |
$2,735.20 |
$2,735.20 |
$2,013.08
|
|
Urinalysis (with microscopy)
|
$31.20 |
$31.20 |
$31.20 |
$36.52
|
|
Urinalysis (without microscopy)
|
$24.80 |
$24.80 |
$24.80 |
$32.50
|
|
Urine Culture Test
|
$42.40 |
$42.40 |
$42.40 |
$65.15
|
|
Vitamin D Test
|
$132.00 |
$132.00 |
$132.00 |
$142.35
|
|
Wrist X-ray
|
$252.00 |
$252.00 |
$252.00 |
$311.17
|