|
Abdominal CT scan (with and without contrast)
|
$2,796.00 |
$2,796.00 |
$2,796.00 |
$2,049.00
|
|
Abdominal CT scan (with contrast)
|
$2,896.80 |
$2,896.80 |
$2,896.80 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$2,237.60 |
$2,237.60 |
$2,237.60 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$3,828.80 |
$3,828.80 |
$3,828.80 |
$3,061.80
|
|
Abdominal MRI (without contrast)
|
$2,930.40 |
$2,930.40 |
$2,930.40 |
$1,902.00
|
|
Abdominal Ultrasound (complete)
|
$965.60 |
$965.60 |
$965.60 |
$755.00
|
|
Abdominal Ultrasound (limited)
|
$705.60 |
$705.60 |
$705.60 |
$629.42
|
|
Ankle X-ray
|
$388.00 |
$388.00 |
$388.00 |
$312.74
|
|
Blood Clotting (PT/INR) Test
|
$91.20 |
$91.20 |
$91.20 |
$45.00
|
|
Blood Clotting (PTT) Test
|
$110.40 |
$110.40 |
$110.40 |
$64.35
|
|
Blood Count (CBC) Test
|
$148.00 |
$148.00 |
$148.00 |
$66.75
|
|
Blood Count (CBC) Test (without differential)
|
$140.00 |
$140.00 |
$140.00 |
$57.50
|
|
Blood Culture Test
|
$164.00 |
$164.00 |
$164.00 |
$112.20
|
|
Bone Density Scan (DEXA)
|
$594.40 |
$594.40 |
$594.40 |
$398.56
|
|
Brain MRA (blood vessel MRI, with and without contrast)
|
$3,762.40 |
$3,762.40 |
$3,762.40 |
$2,650.00
|
|
Brain MRA (blood vessel MRI, with contrast)
|
$3,040.80 |
$3,040.80 |
$3,040.80 |
$1,998.00
|
|
Brain MRA (blood vessel MRI, without contrast)
|
$2,723.20 |
$2,723.20 |
$2,723.20 |
$1,802.40
|
|
Brain MRI (with and without contrast)
|
$3,860.00 |
$3,860.00 |
$3,860.00 |
$2,919.75
|
|
Brain MRI (with contrast)
|
$3,142.40 |
$3,142.40 |
$3,142.40 |
$2,224.96
|
|
Brain MRI (without contrast)
|
$2,892.00 |
$2,892.00 |
$2,892.00 |
$1,830.00
|
|
CT Angiogram of Abdomen and Pelvis
|
$3,775.20 |
$3,775.20 |
$3,775.20 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$2,717.60 |
$2,717.60 |
$2,717.60 |
$2,094.23
|
|
CT Angiogram of the Head
|
$2,718.40 |
$2,718.40 |
$2,718.40 |
$2,094.23
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$4,994.40 |
$4,994.40 |
$4,994.40 |
$3,669.25
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$4,680.00 |
$4,680.00 |
$4,680.00 |
$3,217.18
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$4,107.20 |
$4,107.20 |
$4,107.20 |
$2,418.75
|
|
Carotid Artery Ultrasound (Duplex)
|
$1,416.00 |
$1,416.00 |
$1,416.00 |
$1,059.82
|
|
Chest CT scan (with and without contrast)
|
$2,862.40 |
$2,862.40 |
$2,862.40 |
$2,105.40
|
|
Chest CT scan (with contrast)
|
$2,841.60 |
$2,841.60 |
$2,841.60 |
$1,697.25
|
|
Chest CT scan (without contrast)
|
$2,307.20 |
$2,307.20 |
$2,307.20 |
$1,350.03
|
|
Chest X-ray
|
$369.60 |
$369.60 |
$369.60 |
$303.24
|
|
Chest X-ray (single view)
|
$306.40 |
$306.40 |
$306.40 |
$225.00
|
|
Cholesterol (Lipid) Test
|
$153.60 |
$153.60 |
$153.60 |
$100.00
|
|
Cystoscopy (Bladder Scope)
|
$2,540.80 |
$2,540.80 |
$2,540.80 |
$1,636.00
|
|
Diabetes (HbA1c) Test
|
$91.20 |
$91.20 |
$91.20 |
$70.00
|
|
Diagnostic Mammogram (both breasts)
|
$618.40 |
$618.40 |
$618.40 |
$424.00
|
|
Diagnostic Mammogram (one breast)
|
$503.20 |
$503.20 |
$503.20 |
$297.05
|
|
ER Visit (level 1, minor)
|
$291.20 |
$291.20 |
$291.20 |
$286.51
|
|
ER Visit (level 2)
|
$503.20 |
$503.20 |
$503.20 |
$469.39
|
|
ER Visit (level 3)
|
$808.00 |
$808.00 |
$808.00 |
$827.20
|
|
ER Visit (level 4)
|
$1,204.00 |
$1,204.00 |
$1,204.00 |
$1,330.00
|
|
ER Visit (level 5, high severity)
|
$1,805.60 |
$1,805.60 |
$1,805.60 |
$1,892.80
|
|
Echocardiogram (Heart Ultrasound)
|
$2,751.20 |
$2,751.20 |
$2,751.20 |
$2,021.12
|
|
Established Patient Office Visit (level 1)
|
$242.40 |
$242.40 |
$242.40 |
$115.05
|
|
Foot X-ray
|
$384.80 |
$384.80 |
$384.80 |
$339.50
|
|
Hand X-ray
|
$363.20 |
$363.20 |
$363.20 |
$315.00
|
|
Head CT scan (with and without contrast)
|
$2,708.80 |
$2,708.80 |
$2,708.80 |
$1,914.25
|
|
Head CT scan (with contrast)
|
$2,522.40 |
$2,522.40 |
$2,522.40 |
$1,587.69
|
|
Head CT scan (without contrast)
|
$2,184.00 |
$2,184.00 |
$2,184.00 |
$1,268.90
|
|
Hip X-ray
|
$374.40 |
$374.40 |
$374.40 |
$290.35
|
|
Kidney (Retroperitoneal) Ultrasound (complete)
|
$934.40 |
$934.40 |
$934.40 |
$683.50
|
|
Knee MRI (with and without contrast)
|
$3,798.40 |
$3,798.40 |
$3,798.40 |
$3,008.26
|
|
Knee MRI (with contrast)
|
$3,064.00 |
$3,064.00 |
$3,064.00 |
$2,394.58
|
|
Knee MRI (without contrast)
|
$2,968.80 |
$2,968.80 |
$2,968.80 |
$2,209.22
|
|
Knee X-ray
|
$485.60 |
$485.60 |
$485.60 |
$387.20
|
|
Leg Vein Ultrasound (DVT study, both legs)
|
$1,610.40 |
$1,610.40 |
$1,610.40 |
$1,090.23
|
|
Liver Function Test
|
$136.00 |
$136.00 |
$136.00 |
$93.60
|
|
Lower Back (Lumbar Spine) CT scan (with and without contrast)
|
$2,746.40 |
$2,746.40 |
$2,746.40 |
$1,909.80
|
|
Lower Back (Lumbar Spine) CT scan (with contrast)
|
$2,445.60 |
$2,445.60 |
$2,445.60 |
$1,850.88
|
|
Lower Back (Lumbar Spine) CT scan (without contrast)
|
$2,344.80 |
$2,344.80 |
$2,344.80 |
$1,517.10
|
|
Lower Back (Lumbar Spine) MRI (with and without contrast)
|
$4,159.20 |
$4,159.20 |
$4,159.20 |
$2,750.00
|
|
Lower Back (Lumbar Spine) MRI (with contrast)
|
$3,285.60 |
$3,285.60 |
$3,285.60 |
$2,415.68
|
|
Lower Back (Lumbar Spine) MRI (without contrast)
|
$3,198.40 |
$3,198.40 |
$3,198.40 |
$2,013.08
|
|
Lower Back (Lumbar Spine) X-ray
|
$428.80 |
$428.80 |
$428.80 |
$341.64
|
|
Lung Function Test (Spirometry)
|
$403.20 |
$403.20 |
$403.20 |
$296.91
|
|
Metabolic Blood Panel (Basic)
|
$149.60 |
$149.60 |
$149.60 |
$97.60
|
|
Metabolic Blood Panel (Comprehensive)
|
$240.00 |
$240.00 |
$240.00 |
$130.97
|
|
Neck (Cervical Spine) CT scan (with and without contrast)
|
$2,748.00 |
$2,748.00 |
$2,748.00 |
$1,992.00
|
|
Neck (Cervical Spine) CT scan (with contrast)
|
$2,424.80 |
$2,424.80 |
$2,424.80 |
$1,708.20
|
|
Neck (Cervical Spine) CT scan (without contrast)
|
$2,290.40 |
$2,290.40 |
$2,290.40 |
$1,513.95
|
|
Neck (Cervical Spine) MRI (with and without contrast)
|
$4,184.80 |
$4,184.80 |
$4,184.80 |
$2,750.00
|
|
Neck (Cervical Spine) MRI (with contrast)
|
$3,335.20 |
$3,335.20 |
$3,335.20 |
$2,231.16
|
|
Neck (Cervical Spine) MRI (without contrast)
|
$3,078.40 |
$3,078.40 |
$3,078.40 |
$1,947.58
|
|
Neck MRA (blood vessel MRI, with and without contrast)
|
$3,707.20 |
$3,707.20 |
$3,707.20 |
$2,750.00
|
|
Neck MRA (blood vessel MRI, with contrast)
|
$2,912.80 |
$2,912.80 |
$2,912.80 |
$2,030.23
|
|
Neck MRA (blood vessel MRI, without contrast)
|
$2,754.40 |
$2,754.40 |
$2,754.40 |
$1,790.58
|
|
Nuclear Stress Test (Heart)
|
$4,322.40 |
$4,322.40 |
$4,322.40 |
$3,799.90
|
|
PSA (Prostate) Test
|
$89.60 |
$89.60 |
$89.60 |
$103.85
|
|
Pelvic CT scan (with and without contrast)
|
$2,626.40 |
$2,626.40 |
$2,626.40 |
$1,992.00
|
|
Pelvic CT scan (with contrast)
|
$2,273.60 |
$2,273.60 |
$2,273.60 |
$1,706.25
|
|
Pelvic CT scan (without contrast)
|
$2,008.80 |
$2,008.80 |
$2,008.80 |
$1,366.50
|
|
Pelvic MRI (with and without contrast)
|
$3,984.00 |
$3,984.00 |
$3,984.00 |
$2,713.80
|
|
Pelvic MRI (with contrast)
|
$3,920.80 |
$3,920.80 |
$3,920.80 |
$1,966.42
|
|
Pelvic MRI (without contrast)
|
$2,895.20 |
$2,895.20 |
$2,895.20 |
$1,810.38
|
|
Pelvic Ultrasound (complete)
|
$986.40 |
$986.40 |
$986.40 |
$647.87
|
|
Pelvic Ultrasound (limited)
|
$687.20 |
$687.20 |
$687.20 |
$476.50
|
|
Pregnancy Ultrasound (complete, after first trimester)
|
$920.80 |
$920.80 |
$920.80 |
$607.12
|
|
Pregnancy Ultrasound (first trimester)
|
$731.20 |
$731.20 |
$731.20 |
$592.15
|
|
Rapid Strep Test
|
$84.00 |
$84.00 |
$84.00 |
$72.00
|
|
Screening Mammogram
|
$504.80 |
$504.80 |
$504.80 |
$331.50
|
|
Shoulder MRI (with and without contrast)
|
$4,070.40 |
$4,070.40 |
$4,070.40 |
$2,650.10
|
|
Shoulder MRI (without contrast)
|
$3,198.40 |
$3,198.40 |
$3,198.40 |
$1,938.28
|
|
Shoulder X-ray
|
$378.40 |
$378.40 |
$378.40 |
$307.20
|
|
Sinus CT scan (with and without contrast)
|
$2,796.80 |
$2,796.80 |
$2,796.80 |
$1,871.00
|
|
Sinus CT scan (with contrast)
|
$2,392.80 |
$2,392.80 |
$2,392.80 |
$1,566.40
|
|
Sinus CT scan (without contrast)
|
$1,952.00 |
$1,952.00 |
$1,952.00 |
$1,275.30
|
|
Sleep Study (Polysomnography)
|
$4,141.60 |
$4,141.60 |
$4,141.60 |
$4,141.16
|
|
Thyroid (TSH) Test
|
$144.00 |
$144.00 |
$144.00 |
$110.00
|
|
Thyroid Ultrasound
|
$682.40 |
$682.40 |
$682.40 |
$603.90
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,165.60 |
$4,165.60 |
$4,165.60 |
$2,713.80
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,240.00 |
$3,240.00 |
$3,240.00 |
$2,039.85
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,043.20 |
$3,043.20 |
$3,043.20 |
$2,013.08
|
|
Urinalysis (with microscopy)
|
$80.80 |
$80.80 |
$80.80 |
$36.52
|
|
Urinalysis (without microscopy)
|
$40.00 |
$40.00 |
$40.00 |
$32.50
|
|
Urine Culture Test
|
$116.00 |
$116.00 |
$116.00 |
$65.25
|
|
Vitamin D Test
|
$132.00 |
$132.00 |
$132.00 |
$145.80
|
|
Wrist X-ray
|
$363.20 |
$363.20 |
$363.20 |
$311.20
|