| CT head without then with contrast CPT 70470 • Imaging | $30 | $122 | $215 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $89 | $165 | $241 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $34 | $67 | $100 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $122 | $235 | $348 |
| CT angiography neck CPT 70498 • Imaging | $83 | $119 | $155 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $34 | $507 | $845 |
| MRI brain without contrast CPT 70551 • Imaging | $80 | $205 | $402 |
| MRI brain with contrast CPT 70552 • Imaging | $34 | $263 | $402 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $283 | $443 | $603 |
| Chest X-ray single view CPT 71045 • Imaging | $7 | $13 | $16 |
| Chest X-ray 2 views CPT 71046 • Imaging | $14 | $25 | $43 |
| CT chest without contrast CPT 71250 • Imaging | $155 | $230 | $330 |
| CT chest with contrast CPT 71260 • Imaging | $34 | $208 | $314 |
| CT chest without then with contrast CPT 71270 • Imaging | $34 | $202 | $370 |
| CT angiography chest CPT 71275 • Imaging | $78 | $332 | $529 |
| CT cervical spine without contrast CPT 72125 • Imaging | $30 | $93 | $156 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $44 | $66 | $88 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $47 | $145 | $243 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $80 | $281 | $402 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $119 | $178 | $282 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $34 | $222 | $402 |
| CT pelvis without contrast CPT 72192 • Imaging | $52 | $103 | $154 |
| CT pelvis with contrast CPT 72193 • Imaging | $34 | $182 | $331 |
| X-ray shoulder complete CPT 73030 • Imaging | $22 | $34 | $46 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $121 | $342 | $503 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $33 | $59 | $82 |
| X-ray ankle complete CPT 73610 • Imaging | $11 | $24 | $47 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $201 | $302 | $402 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $80 | $100 | $120 |
| CT abdomen without contrast CPT 74150 • Imaging | $57 | $178 | $258 |
| CT abdomen with contrast CPT 74160 • Imaging | $315 | $322 | $329 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $372 | $395 | $418 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $180 | $237 | $346 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $212 | $359 | $575 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $177 | $463 | $848 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $30 | $95 | $141 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $65 | $87 | $110 |
| Ultrasound transvaginal CPT 76830 • Imaging | $34 | $118 | $218 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $61 | $103 | $173 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $76 | $109 | $156 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $88 | $118 | $171 |
| Screening mammography bilateral CPT 77067 • Imaging | $35 | $101 | $165 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $23 | $46 | $69 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $102 | $427 | $648 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $1 | $2 | $3 |
| Basic metabolic panel CPT 80048 • Laboratory | $3 | $5 | $6 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $7 | $14 | $26 |
| Lipid panel CPT 80061 • Laboratory | $9 | $18 | $33 |
| Hepatic function panel CPT 80076 • Laboratory | $3 | $10 | $20 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $4 | $8 |