| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $155 | $533 | $912 |
| MRI brain without contrast CPT 70551 • Imaging | $30 | $68 | $144 |
| MRI brain with contrast CPT 70552 • Imaging | $30 | $312 | $595 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $369 | $536 | $702 |
| Chest X-ray single view CPT 71045 • Imaging | $20 | $21 | $22 |
| Chest X-ray 2 views CPT 71046 • Imaging | $18 | $28 | $36 |
| CT chest without contrast CPT 71250 • Imaging | $99 | $139 | $159 |
| CT chest with contrast CPT 71260 • Imaging | $30 | $228 | $426 |
| CT chest without then with contrast CPT 71270 • Imaging | $234 | $305 | $376 |
| CT angiography chest CPT 71275 • Imaging | $30 | $205 | $380 |
| CT cervical spine without contrast CPT 72125 • Imaging | $238 | $238 | $238 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $237 | $237 | $237 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $97 | $97 | $97 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $30 | $233 | $525 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $155 | $285 | $416 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $30 | $87 | $145 |
| CT pelvis without contrast CPT 72192 • Imaging | $273 | $273 | $273 |
| CT pelvis with contrast CPT 72193 • Imaging | $30 | $72 | $113 |
| X-ray shoulder complete CPT 73030 • Imaging | $27 | $37 | $54 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $438 | $438 | $438 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $30 | $42 | $54 |
| X-ray ankle complete CPT 73610 • Imaging | $7 | $33 | $58 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $30 | $352 | $675 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $30 | $229 | $525 |
| CT abdomen without contrast CPT 74150 • Imaging | $30 | $73 | $116 |
| CT abdomen with contrast CPT 74160 • Imaging | $428 | $428 | $428 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $136 | $136 | $136 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $201 | $203 | $205 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $320 | $347 | $401 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $361 | $459 | $656 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $30 | $130 | $231 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $30 | $85 | $141 |
| Ultrasound transvaginal CPT 76830 • Imaging | $30 | $95 | $161 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $30 | $118 | $206 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $36 | $110 | $173 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $151 | $186 | $222 |
| Screening mammography bilateral CPT 77067 • Imaging | $87 | $155 | $255 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $77 | $77 | $77 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $359 | $555 | $750 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $3 | $5 |
| Basic metabolic panel CPT 80048 • Laboratory | $7 | $9 | $11 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $9 | $10 | $12 |
| Lipid panel CPT 80061 • Laboratory | $13 | $15 | $18 |
| Hepatic function panel CPT 80076 • Laboratory | $11 | $11 | $11 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $3 | $4 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $3 | $3 | $3 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $2 | $3 | $4 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $15 | $18 | $22 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $27 | $32 | $40 |
| Creatine kinase (CK) total CPT 82550 • Laboratory | $6 | $8 | $9 |