| CT head without then with contrast CPT 70470 • Imaging | $61 | $89 | $116 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $89 | $143 | $245 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $154 | $192 | $230 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $66 | $66 | $66 |
| CT angiography neck CPT 70498 • Imaging | $62 | $226 | $446 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $159 | $559 | $959 |
| MRI brain without contrast CPT 70551 • Imaging | $109 | $311 | $512 |
| MRI brain with contrast CPT 70552 • Imaging | $138 | $369 | $599 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $96 | $427 | $860 |
| Chest X-ray single view CPT 71045 • Imaging | $8 | $14 | $22 |
| Chest X-ray 2 views CPT 71046 • Imaging | $29 | $33 | $43 |
| CT chest without contrast CPT 71250 • Imaging | $38 | $74 | $134 |
| CT chest with contrast CPT 71260 • Imaging | $41 | $121 | $267 |
| CT chest without then with contrast CPT 71270 • Imaging | $66 | $103 | $141 |
| CT angiography chest CPT 71275 • Imaging | $64 | $198 | $443 |
| CT cervical spine without contrast CPT 72125 • Imaging | $35 | $113 | $221 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $35 | $58 | $84 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $35 | $148 | $277 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $39 | $231 | $423 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $77 | $127 | $177 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $71 | $71 | $72 |
| CT pelvis without contrast CPT 72192 • Imaging | $51 | $228 | $580 |
| CT pelvis with contrast CPT 72193 • Imaging | $55 | $184 | $313 |
| X-ray shoulder complete CPT 73030 • Imaging | $8 | $17 | $30 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $30 | $222 | $494 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $9 | $20 | $30 |
| X-ray ankle complete CPT 73610 • Imaging | $21 | $29 | $35 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $65 | $90 | $115 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $30 | $48 | $65 |
| CT abdomen without contrast CPT 74150 • Imaging | $70 | $321 | $572 |
| CT abdomen with contrast CPT 74160 • Imaging | $230 | $451 | $673 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $67 | $208 | $411 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $62 | $235 | $507 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $65 | $223 | $413 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $110 | $238 | $350 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $52 | $88 | $109 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $32 | $48 | $80 |
| Ultrasound transvaginal CPT 76830 • Imaging | $75 | $89 | $105 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $31 | $47 | $64 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $91 | $128 | $201 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $76 | $133 | $202 |
| Screening mammography bilateral CPT 77067 • Imaging | $101 | $146 | $206 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $11 | $26 | $37 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $321 | $417 | $565 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $0 | $3 | $5 |
| Basic metabolic panel CPT 80048 • Laboratory | $1 | $3 | $6 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $2 | $3 | $3 |
| Lipid panel CPT 80061 • Laboratory | $2 | $4 | $6 |
| Hepatic function panel CPT 80076 • Laboratory | $3 | $3 | $3 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $2 | $3 |