| CT head without then with contrast CPT 70470 • Imaging | $120 | $217 | $315 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $201 | $218 | $235 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $59 | $60 | $61 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $69 | $191 | $314 |
| CT angiography neck CPT 70498 • Imaging | $83 | $257 | $431 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $95 | $205 | $379 |
| MRI brain without contrast CPT 70551 • Imaging | $140 | $142 | $143 |
| MRI brain with contrast CPT 70552 • Imaging | $475 | $490 | $506 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $41 | $209 | $475 |
| Chest X-ray single view CPT 71045 • Imaging | $19 | $21 | $24 |
| Chest X-ray 2 views CPT 71046 • Imaging | $17 | $19 | $20 |
| CT chest without contrast CPT 71250 • Imaging | $41 | $50 | $58 |
| CT chest with contrast CPT 71260 • Imaging | $259 | $283 | $316 |
| CT chest without then with contrast CPT 71270 • Imaging | $154 | $271 | $389 |
| CT angiography chest CPT 71275 • Imaging | $41 | $66 | $91 |
| CT cervical spine without contrast CPT 72125 • Imaging | $224 | $236 | $248 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $41 | $82 | $122 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $41 | $107 | $173 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $95 | $116 | $137 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $95 | $116 | $138 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $70 | $203 | $335 |
| CT pelvis without contrast CPT 72192 • Imaging | $51 | $87 | $123 |
| CT pelvis with contrast CPT 72193 • Imaging | $60 | $159 | $259 |
| X-ray shoulder complete CPT 73030 • Imaging | $9 | $9 | $9 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $335 | $412 | $475 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $8 | $12 | $15 |
| X-ray ankle complete CPT 73610 • Imaging | $24 | $29 | $33 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $140 | $352 | $475 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $41 | $195 | $475 |
| CT abdomen without contrast CPT 74150 • Imaging | $41 | $92 | $144 |
| CT abdomen with contrast CPT 74160 • Imaging | $41 | $103 | $165 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $258 | $335 | $411 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $137 | $188 | $213 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $251 | $311 | $342 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $100 | $323 | $434 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $76 | $106 | $136 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $27 | $31 | $35 |
| Ultrasound transvaginal CPT 76830 • Imaging | $33 | $37 | $41 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $34 | $39 | $41 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $36 | $85 | $130 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $121 | $149 | $165 |
| Screening mammography bilateral CPT 77067 • Imaging | $34 | $75 | $100 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $10 | $24 | $38 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $72 | $294 | $414 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $1 | $1 | $2 |
| Basic metabolic panel CPT 80048 • Laboratory | $5 | $5 | $6 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $3 | $4 | $6 |
| Lipid panel CPT 80061 • Laboratory | $3 | $10 | $16 |
| Hepatic function panel CPT 80076 • Laboratory | $5 | $7 | $9 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $2 | $2 |