| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $348 | $461 | $574 |
| MRI brain without contrast CPT 70551 • Imaging | $40 | $194 | $341 |
| MRI brain with contrast CPT 70552 • Imaging | $276 | $361 | $445 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $76 | $170 | $327 |
| Chest X-ray single view CPT 71045 • Imaging | $8 | $17 | $23 |
| Chest X-ray 2 views CPT 71046 • Imaging | $9 | $15 | $22 |
| CT chest without contrast CPT 71250 • Imaging | $134 | $144 | $164 |
| CT chest with contrast CPT 71260 • Imaging | $113 | $176 | $240 |
| CT chest without then with contrast CPT 71270 • Imaging | $45 | $123 | $200 |
| CT angiography chest CPT 71275 • Imaging | $63 | $159 | $255 |
| CT cervical spine without contrast CPT 72125 • Imaging | $132 | $167 | $201 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $37 | $84 | $131 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $37 | $84 | $131 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $195 | $253 | $368 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $124 | $218 | $334 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $196 | $242 | $334 |
| CT pelvis without contrast CPT 72192 • Imaging | $35 | $35 | $35 |
| CT pelvis with contrast CPT 72193 • Imaging | $38 | $131 | $224 |
| X-ray shoulder complete CPT 73030 • Imaging | $21 | $27 | $30 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $65 | $193 | $321 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $20 | $24 | $29 |
| X-ray ankle complete CPT 73610 • Imaging | $6 | $23 | $32 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $373 | $373 | $373 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $206 | $246 | $325 |
| CT abdomen without contrast CPT 74150 • Imaging | $139 | $144 | $155 |
| CT abdomen with contrast CPT 74160 • Imaging | $207 | $207 | $207 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $45 | $141 | $236 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $64 | $125 | $185 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $184 | $270 | $313 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $243 | $315 | $351 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $26 | $65 | $103 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $87 | $93 | $96 |
| Ultrasound transvaginal CPT 76830 • Imaging | $55 | $80 | $105 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $22 | $22 | $22 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $29 | $71 | $110 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $85 | $112 | $139 |
| Screening mammography bilateral CPT 77067 • Imaging | $97 | $107 | $112 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $60 | $60 | $60 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $391 | $411 | $452 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $1 | $2 | $2 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $6 | $7 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $5 | $7 | $8 |
| Lipid panel CPT 80061 • Laboratory | $7 | $9 | $11 |
| Hepatic function panel CPT 80076 • Laboratory | $4 | $5 | $7 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $2 | $3 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $2 | $3 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $1 | $1 | $2 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $10 | $11 | $13 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $14 | $20 | $24 |
| Creatine kinase (CK) total CPT 82550 • Laboratory | $3 | $4 | $5 |