| imaging |
| CT head without contrast | CPT | 70450 | 6 | $1,804 | $938.08 | $717.64 | $1,713.8 | $1,749.88 |
| CT head with contrast | CPT | 70460 | 6 | $2,436 | $1,266.72 | $969.05 | $2,314.2 | $2,362.92 |
| CT head with and without contrast | CPT | 70470 | 6 | $2,706 | $1,407.12 | $1,076.45 | $2,570.7 | $2,624.82 |
| CT neck with contrast | CPT | 70491 | 6 | $2,418 | $1,257.36 | $961.89 | $2,297.1 | $2,345.46 |
| MRI brain without contrast | CPT | 70551 | 6 | $3,175 | $1,651 | $1,263.02 | $3,016.25 | $3,079.75 |
| MRI brain with and without contrast | CPT | 70553 | 6 | $4,601 | $2,392.52 | $1,830.28 | $4,370.95 | $4,462.97 |
| Chest X-ray single view | CPT | 71045 | 6 | $188 | $97.76 | $1.6 | $39.34 | $182.36 |
| Chest X-ray 2 views | CPT | 71046 | 6 | $246 | $127.92 | $97.86 | $233.7 | $238.62 |
| CT chest without contrast | CPT | 71250 | 6 | $2,040 | $1,060.8 | $811.52 | $1,938 | $1,978.8 |
| CT chest with contrast | CPT | 71260 | 6 | $2,721 | $1,414.92 | $1,082.42 | $2,584.95 | $2,639.37 |
| CT chest with and without contrast | CPT | 71270 | 6 | $3,319 | $1,725.88 | $1,320.3 | $3,153.05 | $3,219.43 |
| MRI chest without contrast | CPT | 71550 | 6 | $3,516 | $1,828.32 | $1,398.67 | $3,340.2 | $3,410.52 |
| Lumbosacral spine X-ray | CPT | 72100 | 6 | $311 | $161.72 | $123.72 | $295.45 | $301.67 |
| CT cervical spine without contrast | CPT | 72125 | 6 | $2,535 | $1,318.2 | $1,008.43 | $2,408.25 | $2,458.95 |
| CT thoracic spine without contrast | CPT | 72128 | 6 | $2,123 | $1,103.96 | $844.53 | $2,016.85 | $2,059.31 |
| CT lumbar spine without contrast | CPT | 72131 | 6 | $2,123 | $1,103.96 | $844.53 | $2,016.85 | $2,059.31 |
| MRI cervical spine without contrast | CPT | 72141 | 6 | $3,324 | $1,728.48 | $1,322.29 | $3,157.8 | $3,224.28 |
| MRI thoracic spine without contrast | CPT | 72146 | 6 | $3,324 | $1,728.48 | $1,256.26 | $3,000.1 | $3,224.28 |
| MRI lumbar spine without contrast | CPT | 72148 | 6 | $3,145 | $1,635.4 | $1,214.89 | $2,901.3 | $3,050.65 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 6 | $3,328 | $1,730.56 | $1,323.88 | $3,161.6 | $3,228.16 |
| MRI cervical spine with and without contrast | CPT | 72156 | 6 | $5,618 | $2,921.36 | $2,234.85 | $5,337.1 | $5,449.46 |
| MRI lumbar spine with contrast | CPT | 72158 | 6 | $5,619 | $2,921.88 | $2,235.24 | $5,338.05 | $5,450.43 |
| CT pelvis without contrast | CPT | 72192 | 6 | $3,125 | $1,625 | $1,243.13 | $2,968.75 | $3,031.25 |
| CT pelvis with contrast | CPT | 72193 | 6 | $3,069 | $1,595.88 | $1,220.85 | $2,915.55 | $2,976.93 |
| MRI upper extremity joint without contrast | CPT | 73221 | 6 | $4,046 | $2,103.92 | $651.2 | $2,225.3 | $3,924.62 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 6 | $3,614 | $1,879.28 | $1,327.07 | $3,169.2 | $3,505.58 |
| MRI lower extremity joint without contrast | CPT | 73721 | 6 | $3,757 | $1,953.64 | $1,239.55 | $2,960.2 | $3,644.29 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 6 | $4,368 | $2,271.36 | $1,737.6 | $4,149.6 | $4,236.96 |
| CT abdomen without contrast | CPT | 74150 | 6 | $3,069 | $1,595.88 | $1,220.85 | $2,915.55 | $2,976.93 |
| CT abdomen with contrast | CPT | 74160 | 6 | $2,462 | $1,280.24 | $979.39 | $2,338.9 | $2,388.14 |
| CT abdomen with and without contrast | CPT | 74170 | 6 | $5,957 | $3,097.64 | $2,369.7 | $5,659.15 | $5,778.29 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 6 | $2,245 | $1,167.4 | $893.07 | $2,132.75 | $2,177.65 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 6 | $4,489 | $2,334.28 | $1,785.73 | $4,264.55 | $4,354.33 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 6 | $5,118 | $2,661.36 | $2,035.95 | $4,862.1 | $4,964.46 |
| MRI abdomen without contrast | CPT | 74181 | 6 | $3,186 | $1,656.72 | $1,267.4 | $3,026.7 | $3,090.42 |
| MRI abdomen with and without contrast | CPT | 74183 | 6 | $6,127 | $3,186.04 | $2,437.33 | $5,820.65 | $5,943.19 |
| Abdominal ultrasound complete | CPT | 76700 | 6 | $881 | $458.12 | $350.47 | $836.95 | $854.57 |
| Abdominal ultrasound limited | CPT | 76705 | 6 | $555 | $288.6 | $220.78 | $527.25 | $538.35 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 6 | $738 | $383.76 | $293.58 | $701.1 | $715.86 |
| Obstetric ultrasound first trimester | CPT | 76801 | 6 | $723 | $375.96 | $287.61 | $686.85 | $701.31 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 6 | $785 | $408.2 | $312.28 | $745.75 | $761.45 |
| Transvaginal ultrasound | CPT | 76830 | 6 | $663 | $344.76 | $263.75 | $629.85 | $643.11 |
| Pelvic ultrasound complete | CPT | 76856 | 6 | $663 | $344.76 | $263.75 | $629.85 | $643.11 |
| Scrotal ultrasound | CPT | 76870 | 6 | $575 | $299 | $228.74 | $546.25 | $557.75 |
| Diagnostic mammography bilateral | CPT | 77066 | 6 | $624 | $324.48 | $248.23 | $592.8 | $605.28 |
| Screening mammography bilateral | CPT | 77067 | 6 | $738 | $383.76 | $91.23 | $701.1 | $715.86 |
| EKG tracing only | CPT | 93005 | 6 | $270 | $140.4 | $107.41 | $256.5 | $261.9 |
| Transthoracic echocardiogram complete | CPT | 93306 | 6 | $1,225 | $637 | $487.31 | $1,163.75 | $1,188.25 |
| Transthoracic echocardiogram | CPT | 93307 | 6 | $1,000 | $520 | $397.8 | $950 | $970 |
| lab |
| Basic metabolic panel (BMP) | CPT | 80048 | 6 | $210 | $109.2 | $8.46 | $199.5 | $203.7 |
| Electrolyte panel | CPT | 80051 | 6 | $111 | $57.72 | $7.01 | $105.45 | $107.67 |
| Comprehensive metabolic panel | CPT | 80053 | 6 | $248 | $128.96 | $10.56 | $235.6 | $240.56 |
| Lipid panel | CPT | 80061 | 6 | $179 | $93.08 | $13.39 | $59.17 | $173.63 |
| Renal function panel | CPT | 80069 | 6 | $110 | $57.2 | $8.68 | $104.5 | $106.7 |
| Hepatic function panel | CPT | 80076 | 6 | $134 | $69.68 | $8.17 | $127.3 | $129.98 |
| Urinalysis automated | CPT | 81003 | 6 | $67 | $34.84 | $2.25 | $46.56 | $64.99 |
| Glucose quantitative | CPT | 82947 | 6 | $61 | $31.72 | $3.93 | $44.53 | $59.17 |
| Hemoglobin A1c | CPT | 83036 | 6 | $131 | $68.12 | $9.71 | $124.45 | $127.07 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 6 | $223 | $115.96 | $16.8 | $48.89 | $216.31 |
| Complete blood count with automated differential | CPT | 85025 | 6 | $104 | $54.08 | $7.77 | $98.8 | $100.88 |
| Complete blood count without differential | CPT | 85027 | 6 | $88 | $45.76 | $6.47 | $83.6 | $85.36 |
| Urine culture bacterial | CPT | 87086 | 6 | $108 | $56.16 | $8.07 | $102.6 | $104.76 |
| Urine culture identification | CPT | 87088 | 6 | $114 | $59.28 | $8.09 | $102.6 | $110.58 |
| Tissue exam by pathologist level IV | CPT | 88305 | 6 | $231 | $120.12 | $61.62 | $148.7 | $224.07 |
| surgery |
| Total shoulder arthroplasty | CPT | 23472 | 6 | — | — | $39.78 | $89 | $19,532 |
| Total hip replacement | CPT | 27130 | 6 | — | — | $39.78 | $89 | $17,556 |
| Total knee replacement | CPT | 27447 | 6 | — | — | $39.78 | $89 | $17,556 |