| CT head without then with contrast CPT 70470 • Imaging | $81 | $142 | $257 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $55 | $110 | $211 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $78 | $148 | $258 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $96 | $155 | $248 |
| CT angiography neck CPT 70498 • Imaging | $267 | $478 | $682 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $30 | $192 | $460 |
| MRI brain without contrast CPT 70551 • Imaging | $30 | $243 | $543 |
| MRI brain with contrast CPT 70552 • Imaging | $102 | $382 | $696 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $109 | $367 | $785 |
| Chest X-ray single view CPT 71045 • Imaging | $8 | $20 | $34 |
| Chest X-ray 2 views CPT 71046 • Imaging | $9 | $32 | $62 |
| CT chest without contrast CPT 71250 • Imaging | $100 | $225 | $409 |
| CT chest with contrast CPT 71260 • Imaging | $30 | $159 | $328 |
| CT chest without then with contrast CPT 71270 • Imaging | $77 | $134 | $192 |
| CT angiography chest CPT 71275 • Imaging | $133 | $457 | $809 |
| CT cervical spine without contrast CPT 72125 • Imaging | $30 | $104 | $210 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $30 | $104 | $209 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $114 | $154 | $209 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $89 | $160 | $259 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $121 | $237 | $504 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $83 | $143 | $260 |
| CT pelvis without contrast CPT 72192 • Imaging | $80 | $159 | $259 |
| CT pelvis with contrast CPT 72193 • Imaging | $65 | $133 | $232 |
| X-ray shoulder complete CPT 73030 • Imaging | $9 | $25 | $46 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $30 | $170 | $387 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $21 | $34 | $45 |
| X-ray ankle complete CPT 73610 • Imaging | $13 | $29 | $46 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $98 | $270 | $457 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $100 | $230 | $522 |
| CT abdomen without contrast CPT 74150 • Imaging | $82 | $138 | $196 |
| CT abdomen with contrast CPT 74160 • Imaging | $71 | $132 | $232 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $30 | $300 | $487 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $99 | $146 | $249 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $161 | $263 | $411 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $95 | $327 | $637 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $30 | $87 | $154 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $17 | $74 | $143 |
| Ultrasound transvaginal CPT 76830 • Imaging | $51 | $94 | $157 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $44 | $66 | $116 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $36 | $112 | $187 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $70 | $127 | $209 |
| Screening mammography bilateral CPT 77067 • Imaging | $63 | $102 | $139 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $13 | $36 | $82 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $391 | $517 | $631 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $6 | $15 |
| Basic metabolic panel CPT 80048 • Laboratory | $6 | $8 | $12 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $6 | $10 | $15 |
| Lipid panel CPT 80061 • Laboratory | $10 | $16 | $24 |
| Hepatic function panel CPT 80076 • Laboratory | $4 | $5 | $7 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $0 | $3 | $6 |