| CT head without contrast | CPT 70450 | $1,232.97 |
| CT head with contrast | CPT 70460 | $1,664.40 |
| CT head with and without contrast | CPT 70470 | $1,849.09 |
| CT neck with contrast | CPT 70491 | $1,792.15 |
| MRI brain without contrast | CPT 70551 | $2,451.34 |
| MRI brain with contrast | CPT 70552 | $3,055.05 |
| MRI brain with and without contrast | CPT 70553 | $3,552.18 |
| Chest X-ray single view | CPT 71045 | $121.91 |
| Chest X-ray 2 views | CPT 71046 | $157.68 |
| Chest X-ray 3 views | CPT 71047 | $195.64 |
| CT chest without contrast | CPT 71250 | $1,524.97 |
| CT chest with contrast | CPT 71260 | $2,033.05 |
| CT chest with and without contrast | CPT 71270 | $2,479.81 |
| MRI chest without contrast | CPT 71550 | $2,617.78 |
| MRI chest with contrast | CPT 71551 | $2,870.36 |
| MRI chest with and without contrast | CPT 71552 | $3,639.78 |
| Lumbosacral spine X-ray | CPT 72100 | $205.13 |
| CT cervical spine without contrast | CPT 72125 | $2,017.72 |
| CT thoracic spine without contrast | CPT 72128 | $1,484.82 |
| CT lumbar spine without contrast | CPT 72131 | $1,999.47 |
| MRI cervical spine without contrast | CPT 72141 | $2,137.44 |
| MRI thoracic spine without contrast | CPT 72146 | $2,520.69 |
| MRI lumbar spine without contrast | CPT 72148 | $2,404.62 |
| MRI lumbar spine with and without contrast | CPT 72149 | $2,544.78 |
| MRI cervical spine with and without contrast | CPT 72156 | $3,612.04 |
| MRI lumbar spine with contrast | CPT 72158 | $4,295.32 |
| CT pelvis without contrast | CPT 72192 | $2,060.06 |
| CT pelvis with contrast | CPT 72193 | $2,574.71 |
| MRI upper extremity joint without contrast | CPT 73221 | $2,714.14 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $4,268.31 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,859.41 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $3,324.42 |
| CT abdomen without contrast | CPT 74150 | $1,331.52 |
| CT abdomen with contrast | CPT 74160 | $2,580.55 |
| CT abdomen with and without contrast | CPT 74170 | $2,716.33 |
| CT abdomen and pelvis without contrast | CPT 74176 | $1,695.79 |
| CT abdomen and pelvis with contrast | CPT 74177 | $3,390.85 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $3,866.08 |
| MRI abdomen without contrast | CPT 74181 | $2,098.02 |
| MRI abdomen with and without contrast | CPT 74183 | $3,227.33 |
| Abdominal ultrasound complete | CPT 76700 | $763.58 |
| Abdominal ultrasound limited | CPT 76705 | $306.60 |
| Retroperitoneal ultrasound complete | CPT 76770 | $685.47 |
| Obstetric ultrasound first trimester | CPT 76801 | $436.54 |
| Obstetric ultrasound after first trimester | CPT 76805 | $620.50 |
| Transvaginal ultrasound | CPT 76830 | $602.25 |
| Pelvic ultrasound complete | CPT 76856 | $678.90 |
| Scrotal ultrasound | CPT 76870 | $508.81 |
| Diagnostic mammography bilateral | CPT 77066 | $862.86 |
| Screening mammography bilateral | CPT 77067 | $549.69 |
| EKG tracing only | CPT 93005 | $176.66 |
| Transthoracic echocardiogram complete | CPT 93306 | $886.95 |
| Transthoracic echocardiogram | CPT 93307 | $300.76 |
| Basic metabolic panel (BMP) | CPT 80048 | $102.93 |
| Electrolyte panel | CPT 80051 | $80.30 |
| Comprehensive metabolic panel | CPT 80053 | $126.29 |
| Lipid panel | CPT 80061 | $146.91 |
| Renal function panel | CPT 80069 | $105.12 |
| Hepatic function panel | CPT 80076 | $94.17 |
| Urinalysis non-automated | CPT 81002 | $23.36 |
| Urinalysis automated | CPT 81003 | $24.90 |
| Glucose quantitative | CPT 82947 | $51.46 |
| Hemoglobin A1c | CPT 83036 | $93.44 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $41.84 |
| Complete blood count with automated differential | CPT 85025 | $74.46 |
| Complete blood count without differential | CPT 85027 | $67.16 |
| Urine culture bacterial | CPT 87086 | $78.11 |
| Urine culture identification | CPT 87088 | $89.64 |
| Tissue exam by pathologist level IV | CPT 88305 | $113.07 |
| Total shoulder arthroplasty | CPT 23472 | $73.00 |
| Total hip replacement | CPT 27130 | $73.00 |
| Total knee replacement | CPT 27447 | $73.00 |
