| CT head without then with contrast CPT 70470 • Imaging | $62 | $87 | $112 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $76 | $144 | $212 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $101 | $179 | $258 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $123 | $239 | $319 |
| CT angiography neck CPT 70498 • Imaging | $155 | $336 | $517 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $105 | $148 | $192 |
| MRI brain without contrast CPT 70551 • Imaging | $23 | $196 | $556 |
| MRI brain with contrast CPT 70552 • Imaging | $542 | $542 | $542 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $204 | $469 | $811 |
| Chest X-ray single view CPT 71045 • Imaging | $7 | $15 | $21 |
| Chest X-ray 2 views CPT 71046 • Imaging | $15 | $25 | $33 |
| CT chest without contrast CPT 71250 • Imaging | $96 | $219 | $275 |
| CT chest with contrast CPT 71260 • Imaging | $104 | $220 | $280 |
| CT chest without then with contrast CPT 71270 • Imaging | $68 | $68 | $68 |
| CT angiography chest CPT 71275 • Imaging | $162 | $408 | $537 |
| CT cervical spine without contrast CPT 72125 • Imaging | $56 | $73 | $90 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $56 | $73 | $90 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $90 | $187 | $285 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $23 | $290 | $564 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $132 | $351 | $466 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $131 | $301 | $538 |
| CT pelvis without contrast CPT 72192 • Imaging | $96 | $159 | $221 |
| CT pelvis with contrast CPT 72193 • Imaging | $57 | $80 | $103 |
| X-ray shoulder complete CPT 73030 • Imaging | $8 | $15 | $21 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $66 | $308 | $551 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $9 | $25 | $39 |
| X-ray ankle complete CPT 73610 • Imaging | $16 | $23 | $30 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $66 | $246 | $551 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $23 | $174 | $530 |
| CT abdomen without contrast CPT 74150 • Imaging | $58 | $61 | $65 |
| CT abdomen with contrast CPT 74160 • Imaging | $353 | $353 | $353 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $452 | $452 | $452 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $69 | $147 | $275 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $172 | $274 | $374 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $190 | $331 | $472 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $73 | $82 | $92 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $65 | $118 | $161 |
| Ultrasound transvaginal CPT 76830 • Imaging | $63 | $105 | $138 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $61 | $93 | $139 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $73 | $113 | $154 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $88 | $112 | $137 |
| Screening mammography bilateral CPT 77067 • Imaging | $31 | $79 | $113 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $18 | $49 | $80 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $291 | $463 | $635 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $4 | $7 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $9 | $18 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $4 | $6 | $8 |
| Lipid panel CPT 80061 • Laboratory | $9 | $13 | $21 |
| Hepatic function panel CPT 80076 • Laboratory | $6 | $11 | $17 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $2 | $3 |