| CT head without then with contrast CPT 70470 • Imaging | $119 | $136 | $152 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $30 | $78 | $115 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $71 | $116 | $160 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $30 | $62 | $87 |
| CT angiography neck CPT 70498 • Imaging | $30 | $76 | $111 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $30 | $156 | $359 |
| MRI brain without contrast CPT 70551 • Imaging | $40 | $124 | $200 |
| MRI brain with contrast CPT 70552 • Imaging | $30 | $149 | $304 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $30 | $141 | $359 |
| Chest X-ray single view CPT 71045 • Imaging | $16 | $20 | $23 |
| Chest X-ray 2 views CPT 71046 • Imaging | $18 | $23 | $29 |
| CT chest without contrast CPT 71250 • Imaging | $30 | $72 | $134 |
| CT chest with contrast CPT 71260 • Imaging | $79 | $134 | $168 |
| CT chest without then with contrast CPT 71270 • Imaging | $30 | $103 | $192 |
| CT angiography chest CPT 71275 • Imaging | $30 | $96 | $194 |
| CT cervical spine without contrast CPT 72125 • Imaging | $30 | $80 | $175 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $30 | $79 | $171 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $30 | $78 | $170 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $30 | $73 | $139 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $30 | $112 | $212 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $94 | $131 | $196 |
| CT pelvis without contrast CPT 72192 • Imaging | $69 | $77 | $85 |
| CT pelvis with contrast CPT 72193 • Imaging | $30 | $106 | $214 |
| X-ray shoulder complete CPT 73030 • Imaging | $18 | $29 | $37 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $86 | $149 | $206 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $18 | $29 | $39 |
| X-ray ankle complete CPT 73610 • Imaging | $9 | $24 | $32 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $67 | $76 | $85 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $156 | $186 | $206 |
| CT abdomen without contrast CPT 74150 • Imaging | $30 | $76 | $139 |
| CT abdomen with contrast CPT 74160 • Imaging | $63 | $72 | $80 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $30 | $141 | $249 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $62 | $146 | $192 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $205 | $276 | $313 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $100 | $278 | $351 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $30 | $66 | $118 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $30 | $72 | $96 |
| Ultrasound transvaginal CPT 76830 • Imaging | $35 | $76 | $105 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $29 | $48 | $71 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $34 | $81 | $127 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $63 | $121 | $162 |
| Screening mammography bilateral CPT 77067 • Imaging | $79 | $104 | $130 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $36 | $38 | $39 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $321 | $374 | $462 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $2 | $3 |
| Basic metabolic panel CPT 80048 • Laboratory | $3 | $7 | $12 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $6 | $10 | $15 |
| Lipid panel CPT 80061 • Laboratory | $9 | $13 | $19 |
| Hepatic function panel CPT 80076 • Laboratory | $5 | $8 | $12 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $3 | $4 |