| CT head without contrast | CPT 70450 | $323.38 |
| CT head with contrast | CPT 70460 | $821.93 |
| CT head with and without contrast | CPT 70470 | $344.33 |
| CT neck with contrast | CPT 70491 | $707.62 |
| MRI brain without contrast | CPT 70551 | $709.60 |
| MRI brain with contrast | CPT 70552 | $3,712.82 |
| MRI brain with and without contrast | CPT 70553 | $709.60 |
| Chest X-ray single view | CPT 71045 | $61.89 |
| Chest X-ray 2 views | CPT 71046 | $294.65 |
| Chest X-ray 3 views | CPT 71047 | $463.20 |
| CT chest without contrast | CPT 71250 | $323.38 |
| CT chest with contrast | CPT 71260 | $323.38 |
| CT chest with and without contrast | CPT 71270 | $349.62 |
| MRI chest without contrast | CPT 71550 | $707.62 |
| MRI chest with contrast | CPT 71551 | $3,208.72 |
| MRI chest with and without contrast | CPT 71552 | $3,646.76 |
| Lumbosacral spine X-ray | CPT 72100 | $323.38 |
| CT cervical spine without contrast | CPT 72125 | $323.38 |
| CT thoracic spine without contrast | CPT 72128 | $323.38 |
| CT lumbar spine without contrast | CPT 72131 | $323.38 |
| MRI cervical spine without contrast | CPT 72141 | $709.60 |
| MRI thoracic spine without contrast | CPT 72146 | $709.60 |
| MRI lumbar spine without contrast | CPT 72148 | $709.60 |
| MRI lumbar spine with and without contrast | CPT 72149 | $6,029.44 |
| MRI cervical spine with and without contrast | CPT 72156 | $709.60 |
| MRI lumbar spine with contrast | CPT 72158 | $1,113.68 |
| CT pelvis without contrast | CPT 72192 | $716.75 |
| CT pelvis with contrast | CPT 72193 | $335.07 |
| Shoulder X-ray | CPT 73030 | $263.15 |
| Humerus X-ray | CPT 73060 | $410.15 |
| Hand X-ray 3 views | CPT 73130 | $273.65 |
| MRI upper extremity joint without contrast | CPT 73221 | $747.50 |
| MRI upper extremity joint with and without contrast | CPT 73223 | $1,113.64 |
| Knee X-ray 1-2 views | CPT 73560 | $218.27 |
| Ankle X-ray 3 views | CPT 73610 | $262.87 |
| MRI lower extremity joint without contrast | CPT 73721 | $2,192.06 |
| MRI lower extremity joint with and without contrast | CPT 73723 | $845.21 |
| CT abdomen without contrast | CPT 74150 | $323.38 |
| CT abdomen with contrast | CPT 74160 | $821.93 |
| CT abdomen with and without contrast | CPT 74170 | $349.62 |
| CT abdomen and pelvis without contrast | CPT 74176 | $716.75 |
| CT abdomen and pelvis with contrast | CPT 74177 | $1,114.69 |
| CT abdomen and pelvis with and without contrast | CPT 74178 | $323.38 |
| MRI abdomen without contrast | CPT 74181 | $716.75 |
| MRI abdomen with and without contrast | CPT 74183 | $123.09 |
| Abdominal ultrasound complete | CPT 76700 | $323.38 |
| Abdominal ultrasound limited | CPT 76705 | $380.38 |
| Retroperitoneal ultrasound complete | CPT 76770 | $323.38 |
| Obstetric ultrasound first trimester | CPT 76801 | $786.11 |
| Obstetric ultrasound after first trimester | CPT 76805 | $903.92 |
| Transvaginal ultrasound | CPT 76830 | $963.38 |
| Pelvic ultrasound complete | CPT 76856 | $344.33 |
| Scrotal ultrasound | CPT 76870 | $339.13 |
| Diagnostic mammography bilateral | CPT 77066 | $480.99 |
| Screening mammography bilateral | CPT 77067 | $210.99 |
| EKG complete | CPT 93000 | $514.29 |
| EKG tracing only | CPT 93005 | $1,007.14 |
| Transthoracic echocardiogram complete | CPT 93306 | $1,409.03 |
| Transthoracic echocardiogram | CPT 93307 | $1,259.97 |
| Stress echocardiogram | CPT 93350 | $1,332.64 |
| Basic metabolic panel (BMP) | CPT 80048 | $269.85 |
| Electrolyte panel | CPT 80051 | $264.31 |
| Comprehensive metabolic panel | CPT 80053 | $33.26 |
| Lipid panel | CPT 80061 | $20.92 |
| Renal function panel | CPT 80069 | $38.75 |
| Hepatic function panel | CPT 80076 | $65.24 |
| Urinalysis non-automated | CPT 81002 | $92.11 |
| Urinalysis automated | CPT 81003 | $10.02 |
| Glucose quantitative | CPT 82947 | $75.80 |
| Hemoglobin A1c | CPT 83036 | $40.49 |
| Thyroid stimulating hormone (TSH) | CPT 84443 | $74.97 |
| Complete blood count with automated differential | CPT 85025 | $36.45 |
| Complete blood count without differential | CPT 85027 | $30.33 |
| Urine culture bacterial | CPT 87086 | $10.02 |
| Urine culture identification | CPT 87088 | $67.97 |
| Tissue exam by pathologist level IV | CPT 88305 | $986.49 |
| Office visit, new patient, 45-59 min | CPT 99204 | $1,941.50 |
| Office visit, new patient, 60-74 min | CPT 99205 | $1,904.71 |
| Office visit, established patient, 5 min | CPT 99211 | $479.59 |
| Office visit, established patient, 20-29 minutes | CPT 99213 | $175.46 |
| Office visit, established patient, 30-39 minutes | CPT 99214 | $767.19 |
| Office visit, established patient, 40-54 min | CPT 99215 | $412.91 |
