| CT maxillofacial with contrast CPT 70487 • Imaging | $78 | $355 | $631 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $120 | $303 | $619 |
| CT angiography neck CPT 70498 • Imaging | $152 | $496 | $1,165 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $50 | $430 | $990 |
| MRI brain without contrast CPT 70551 • Imaging | $50 | $267 | $619 |
| MRI brain with contrast CPT 70552 • Imaging | $121 | $481 | $840 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $50 | $299 | $692 |
| Chest X-ray single view CPT 71045 • Imaging | $17 | $27 | $43 |
| Chest X-ray 2 views CPT 71046 • Imaging | $28 | $29 | $29 |
| CT chest without contrast CPT 71250 • Imaging | $102 | $144 | $171 |
| CT chest with contrast CPT 71260 • Imaging | $110 | $129 | $163 |
| CT chest without then with contrast CPT 71270 • Imaging | $171 | $359 | $547 |
| CT angiography chest CPT 71275 • Imaging | $126 | $407 | $689 |
| CT cervical spine without contrast CPT 72125 • Imaging | $89 | $204 | $353 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $68 | $123 | $171 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $114 | $212 | $350 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $50 | $282 | $614 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $50 | $218 | $419 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $50 | $275 | $615 |
| CT pelvis without contrast CPT 72192 • Imaging | $240 | $240 | $240 |
| CT pelvis with contrast CPT 72193 • Imaging | $102 | $142 | $171 |
| X-ray shoulder complete CPT 73030 • Imaging | $23 | $41 | $79 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $180 | $184 | $187 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $23 | $35 | $54 |
| X-ray ankle complete CPT 73610 • Imaging | $23 | $31 | $46 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $746 | $746 | $746 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $50 | $290 | $642 |
| CT abdomen without contrast CPT 74150 • Imaging | $157 | $164 | $171 |
| CT abdomen with contrast CPT 74160 • Imaging | $88 | $263 | $438 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $171 | $177 | $184 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $154 | $189 | $229 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $124 | $212 | $313 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $171 | $262 | $350 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $72 | $142 | $251 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $65 | $159 | $336 |
| Ultrasound transvaginal CPT 76830 • Imaging | $105 | $195 | $319 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $47 | $68 | $90 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $72 | $130 | $234 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $89 | $118 | $139 |
| Screening mammography bilateral CPT 77067 • Imaging | $38 | $86 | $142 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $14 | $30 | $47 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $68 | $197 | $319 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $8 | $17 |
| Basic metabolic panel CPT 80048 • Laboratory | $7 | $9 | $11 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $12 | $15 | $19 |
| Lipid panel CPT 80061 • Laboratory | $11 | $18 | $24 |
| Hepatic function panel CPT 80076 • Laboratory | $6 | $8 | $11 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $3 | $4 | $6 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $3 | $6 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $2 | $3 | $4 |