| MRI joint upper extremity without contrast CPT 73221 • Imaging | $99 | $101 | $103 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $14 | $14 | $14 |
| X-ray ankle complete CPT 73610 • Imaging | $15 | $30 | $54 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $98 | $236 | $374 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $44 | $170 | $334 |
| CT abdomen without contrast CPT 74150 • Imaging | $87 | $87 | $87 |
| CT abdomen with contrast CPT 74160 • Imaging | $93 | $93 | $93 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $487 | $487 | $487 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $127 | $201 | $275 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $55 | $155 | $275 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $55 | $159 | $275 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $216 | $216 | $216 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $200 | $200 | $200 |
| Ultrasound transvaginal CPT 76830 • Imaging | $221 | $221 | $221 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $198 | $198 | $198 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $27 | $61 | $96 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $74 | $103 | $131 |
| Screening mammography bilateral CPT 77067 • Imaging | $29 | $66 | $98 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $15 | $15 | $15 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $381 | $522 | $662 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $15 | $15 | $15 |
| Lipid panel CPT 80061 • Laboratory | $7 | $9 | $10 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $3 | $3 | $3 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $4 | $4 | $4 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $11 | $11 | $12 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $4 | $4 | $4 |
| Creatine kinase (CK) total CPT 82550 • Laboratory | $5 | $5 | $5 |
| Ferritin CPT 82728 • Laboratory | $5 | $8 | $10 |
| Glucose quantitative blood CPT 82947 • Laboratory | $6 | $6 | $6 |
| Hemoglobin A1c CPT 83036 • Laboratory | $16 | $16 | $16 |
| Iron binding capacity CPT 83550 • Laboratory | $7 | $7 | $7 |
| Thyroid stimulating hormone (TSH) CPT 84443 • Laboratory | $6 | $6 | $6 |
| Prothrombin time (PT) CPT 85610 • Laboratory | $7 | $7 | $7 |
| Partial thromboplastin time (PTT) CPT 85730 • Laboratory | $5 | $5 | $5 |
| Cyclic citrullinated peptide antibody CPT 86200 • Laboratory | $9 | $9 | $9 |
| TB skin test intradermal CPT 86580 • Laboratory | $7 | $11 | $15 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $19 | $19 | $19 |
| Strep A assay with optic observation CPT 87880 • Laboratory | $12 | $19 | $25 |
| Cordocentesis fetal blood sampling CPT 59012 • Maternity | $174 | $174 | $174 |
| Chorionic villus sampling CPT 59015 • Maternity | $102 | $102 | $102 |
| Fetal non-stress test CPT 59025 • Maternity | $26 | $36 | $43 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $3,605 | $3,605 | $3,605 |
| Vaginal delivery only CPT 59409 • Maternity | $951 | $951 | $951 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $842 | $884 | $926 |
| Postpartum care only CPT 59430 • Maternity | $339 | $339 | $339 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,013 | $2,881 | $3,749 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,013 | $2,013 | $2,013 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $73 | $73 | $73 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $136 | $136 | $136 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $44 | $46 | $48 |