| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $138 | $214 | $316 |
| MRI brain without contrast CPT 70551 • Imaging | $129 | $262 | $330 |
| MRI brain with contrast CPT 70552 • Imaging | $178 | $317 | $456 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $203 | $334 | $538 |
| Chest X-ray single view CPT 71045 • Imaging | $8 | $16 | $21 |
| Chest X-ray 2 views CPT 71046 • Imaging | $18 | $25 | $33 |
| CT chest without contrast CPT 71250 • Imaging | $28 | $98 | $203 |
| CT chest with contrast CPT 71260 • Imaging | $71 | $163 | $255 |
| CT chest without then with contrast CPT 71270 • Imaging | $56 | $131 | $206 |
| CT angiography chest CPT 71275 • Imaging | $159 | $273 | $397 |
| CT cervical spine without contrast CPT 72125 • Imaging | $85 | $89 | $93 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $43 | $96 | $148 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $55 | $71 | $87 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $129 | $258 | $322 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $64 | $149 | $207 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $61 | $171 | $322 |
| CT pelvis without contrast CPT 72192 • Imaging | $44 | $70 | $95 |
| CT pelvis with contrast CPT 72193 • Imaging | $101 | $194 | $250 |
| X-ray shoulder complete CPT 73030 • Imaging | $17 | $29 | $44 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $44 | $144 | $271 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $10 | $34 | $48 |
| X-ray ankle complete CPT 73610 • Imaging | $23 | $27 | $32 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $117 | $256 | $443 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $118 | $243 | $340 |
| CT abdomen without contrast CPT 74150 • Imaging | $49 | $98 | $142 |
| CT abdomen with contrast CPT 74160 • Imaging | $52 | $82 | $111 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $57 | $71 | $84 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $76 | $166 | $232 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $101 | $236 | $323 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $176 | $299 | $362 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $67 | $78 | $97 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $64 | $99 | $142 |
| Ultrasound transvaginal CPT 76830 • Imaging | $28 | $92 | $149 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $61 | $111 | $184 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $31 | $60 | $104 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $41 | $83 | $130 |
| Screening mammography bilateral CPT 77067 • Imaging | $59 | $86 | $106 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $32 | $50 | $69 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $91 | $323 | $510 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $5 | $7 |
| Basic metabolic panel CPT 80048 • Laboratory | $5 | $8 | $11 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $7 | $7 | $7 |
| Lipid panel CPT 80061 • Laboratory | $8 | $13 | $19 |
| Hepatic function panel CPT 80076 • Laboratory | $7 | $9 | $11 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $3 | $4 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $3 | $4 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $1 | $2 | $4 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $12 | $12 | $13 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $18 | $21 | $24 |
| Creatine kinase (CK) total CPT 82550 • Laboratory | $3 | $4 | $5 |