| CT head without then with contrast CPT 70470 • Imaging | $86 | $123 | $159 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $76 | $98 | $120 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $49 | $64 | $78 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $38 | $113 | $181 |
| CT angiography neck CPT 70498 • Imaging | $152 | $166 | $180 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $140 | $238 | $336 |
| MRI brain without contrast CPT 70551 • Imaging | $103 | $307 | $475 |
| MRI brain with contrast CPT 70552 • Imaging | $121 | $218 | $335 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $38 | $155 | $327 |
| Chest X-ray single view CPT 71045 • Imaging | $8 | $33 | $55 |
| Chest X-ray 2 views CPT 71046 • Imaging | $21 | $26 | $36 |
| CT chest without contrast CPT 71250 • Imaging | $80 | $182 | $281 |
| CT chest with contrast CPT 71260 • Imaging | $38 | $68 | $110 |
| CT chest without then with contrast CPT 71270 • Imaging | $141 | $291 | $442 |
| CT angiography chest CPT 71275 • Imaging | $38 | $85 | $139 |
| CT cervical spine without contrast CPT 72125 • Imaging | $68 | $79 | $91 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $44 | $56 | $68 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $94 | $104 | $114 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $64 | $205 | $335 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $38 | $116 | $187 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $159 | $266 | $335 |
| CT pelvis without contrast CPT 72192 • Imaging | $143 | $143 | $143 |
| CT pelvis with contrast CPT 72193 • Imaging | $38 | $237 | $593 |
| X-ray shoulder complete CPT 73030 • Imaging | $26 | $42 | $66 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $38 | $49 | $60 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $7 | $32 | $57 |
| X-ray ankle complete CPT 73610 • Imaging | $8 | $26 | $38 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $59 | $197 | $335 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $58 | $158 | $238 |
| CT abdomen without contrast CPT 74150 • Imaging | $38 | $56 | $73 |
| CT abdomen with contrast CPT 74160 • Imaging | $88 | $123 | $158 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $61 | $61 | $61 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $76 | $156 | $237 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $158 | $302 | $385 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $87 | $356 | $490 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $135 | $193 | $251 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $38 | $59 | $88 |
| Ultrasound transvaginal CPT 76830 • Imaging | $47 | $68 | $90 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $62 | $116 | $146 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $72 | $109 | $145 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $89 | $140 | $184 |
| Screening mammography bilateral CPT 77067 • Imaging | $35 | $87 | $150 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $14 | $20 | $27 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $75 | $373 | $631 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $3 | $10 | $17 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $4 | $4 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $6 | $6 | $6 |
| Lipid panel CPT 80061 • Laboratory | $6 | $14 | $24 |
| Hepatic function panel CPT 80076 • Laboratory | $3 | $3 | $3 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $4 | $6 |