| imaging |
| CT head without contrast | CPT | 70450 | 0 | $376 | — | — | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $529 | — | — | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $659 | — | — | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $751 | — | — | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $1,042 | — | — | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $71 | — | — | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $99 | — | — | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $126 | — | — | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $528 | — | — | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $637 | — | — | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $114 | — | — | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $539 | — | — | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $529 | — | — | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $529 | — | — | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $730 | — | — | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $731 | — | — | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $473 | — | — | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $95 | — | — | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $94 | — | — | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $104 | — | — | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $101 | — | — | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $102 | — | — | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $485 | — | — | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $749 | — | — | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $649 | — | — | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $1,012 | — | — | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $1,132 | — | — | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $918 | — | — | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $400 | — | — | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $439 | — | — | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $448 | — | — | — | — | — |
| EKG complete | CPT | 93000 | 0 | $55 | — | — | — | — | — |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $42 | — | — | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $23 | — | — | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $40 | — | — | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $56 | — | — | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $34 | — | — | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $27 | — | — | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $17 | — | — | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $41 | — | — | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $70 | — | — | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $33 | — | — | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $29 | — | — | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $34 | — | — | — | — | — |
