| CT head without then with contrast CPT 70470 • Imaging | $86 | $124 | $167 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $45 | $214 | $522 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $45 | $98 | $171 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $34 | $112 | $181 |
| CT angiography neck CPT 70498 • Imaging | $86 | $467 | $1,165 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $45 | $360 | $990 |
| MRI brain without contrast CPT 70551 • Imaging | $103 | $274 | $619 |
| MRI brain with contrast CPT 70552 • Imaging | $121 | $275 | $605 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $50 | $376 | $993 |
| Chest X-ray single view CPT 71045 • Imaging | $6 | $23 | $43 |
| Chest X-ray 2 views CPT 71046 • Imaging | $7 | $22 | $44 |
| CT chest without contrast CPT 71250 • Imaging | $45 | $137 | $349 |
| CT chest with contrast CPT 71260 • Imaging | $45 | $155 | $440 |
| CT chest without then with contrast CPT 71270 • Imaging | $34 | $381 | $727 |
| CT angiography chest CPT 71275 • Imaging | $120 | $176 | $252 |
| CT cervical spine without contrast CPT 72125 • Imaging | $68 | $227 | $493 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $120 | $258 | $483 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $45 | $170 | $350 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $45 | $224 | $419 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $50 | $218 | $419 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $125 | $245 | $419 |
| CT pelvis without contrast CPT 72192 • Imaging | $171 | $277 | $383 |
| CT pelvis with contrast CPT 72193 • Imaging | $51 | $190 | $440 |
| X-ray shoulder complete CPT 73030 • Imaging | $23 | $31 | $45 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $45 | $270 | $641 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $6 | $24 | $44 |
| X-ray ankle complete CPT 73610 • Imaging | $19 | $46 | $86 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $63 | $163 | $250 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $45 | $279 | $642 |
| CT abdomen without contrast CPT 74150 • Imaging | $171 | $245 | $392 |
| CT abdomen with contrast CPT 74160 • Imaging | $88 | $288 | $605 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $45 | $280 | $515 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $51 | $231 | $550 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $126 | $177 | $239 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $171 | $202 | $264 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $45 | $92 | $135 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $38 | $137 | $336 |
| Ultrasound transvaginal CPT 76830 • Imaging | $17 | $59 | $91 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $51 | $142 | $314 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $72 | $161 | $337 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $51 | $111 | $175 |
| Screening mammography bilateral CPT 77067 • Imaging | $68 | $174 | $344 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $14 | $67 | $170 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $51 | $118 | $261 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $1 | $7 | $17 |
| Basic metabolic panel CPT 80048 • Laboratory | $1 | $6 | $11 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $9 | $10 | $12 |
| Lipid panel CPT 80061 • Laboratory | $6 | $15 | $24 |
| Hepatic function panel CPT 80076 • Laboratory | $3 | $7 | $11 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $3 | $6 |