| CT head without then with contrast CPT 70470 • Imaging | $73 | $98 | $123 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $49 | $71 | $93 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $55 | $88 | $122 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $67 | $122 | $187 |
| CT angiography neck CPT 70498 • Imaging | $279 | $295 | $320 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $86 | $220 | $302 |
| MRI brain without contrast CPT 70551 • Imaging | $72 | $255 | $375 |
| MRI brain with contrast CPT 70552 • Imaging | $87 | $179 | $344 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $81 | $255 | $352 |
| Chest X-ray single view CPT 71045 • Imaging | $9 | $17 | $26 |
| Chest X-ray 2 views CPT 71046 • Imaging | $11 | $20 | $25 |
| CT chest without contrast CPT 71250 • Imaging | $82 | $125 | $163 |
| CT chest with contrast CPT 71260 • Imaging | $102 | $115 | $129 |
| CT chest without then with contrast CPT 71270 • Imaging | $71 | $148 | $224 |
| CT angiography chest CPT 71275 • Imaging | $88 | $246 | $325 |
| CT cervical spine without contrast CPT 72125 • Imaging | $49 | $104 | $159 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $101 | $102 | $102 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $79 | $114 | $149 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $71 | $183 | $375 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $209 | $236 | $249 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $72 | $196 | $375 |
| CT pelvis without contrast CPT 72192 • Imaging | $62 | $101 | $140 |
| CT pelvis with contrast CPT 72193 • Imaging | $66 | $122 | $177 |
| X-ray shoulder complete CPT 73030 • Imaging | $7 | $22 | $35 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $155 | $215 | $249 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $27 | $32 | $35 |
| X-ray ankle complete CPT 73610 • Imaging | $8 | $25 | $37 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $65 | $198 | $375 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $126 | $201 | $249 |
| CT abdomen without contrast CPT 74150 • Imaging | $58 | $108 | $167 |
| CT abdomen with contrast CPT 74160 • Imaging | $62 | $136 | $209 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $80 | $140 | $201 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $100 | $164 | $225 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $105 | $252 | $369 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $299 | $353 | $413 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $40 | $99 | $119 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $52 | $78 | $111 |
| Ultrasound transvaginal CPT 76830 • Imaging | $61 | $102 | $141 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $74 | $90 | $107 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $90 | $109 | $130 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $49 | $122 | $163 |
| Screening mammography bilateral CPT 77067 • Imaging | $94 | $113 | $132 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $10 | $30 | $41 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $58 | $142 | $357 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $3 | $5 | $11 |
| Basic metabolic panel CPT 80048 • Laboratory | $1 | $3 | $5 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $1 | $4 | $7 |
| Lipid panel CPT 80061 • Laboratory | $2 | $4 | $6 |
| Hepatic function panel CPT 80076 • Laboratory | $3 | $5 | $5 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $0 | $1 | $2 |