| CT head without then with contrast CPT 70470 • Imaging | $133 | $181 | $228 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $41 | $85 | $172 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $54 | $142 | $198 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $66 | $159 | $238 |
| CT angiography neck CPT 70498 • Imaging | $83 | $112 | $165 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $42 | $319 | $625 |
| MRI brain without contrast CPT 70551 • Imaging | $71 | $192 | $370 |
| MRI brain with contrast CPT 70552 • Imaging | $111 | $291 | $393 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $42 | $276 | $664 |
| Chest X-ray single view CPT 71045 • Imaging | $9 | $14 | $17 |
| Chest X-ray 2 views CPT 71046 • Imaging | $25 | $41 | $59 |
| CT chest without contrast CPT 71250 • Imaging | $52 | $140 | $289 |
| CT chest with contrast CPT 71260 • Imaging | $56 | $119 | $239 |
| CT chest without then with contrast CPT 71270 • Imaging | $70 | $100 | $130 |
| CT angiography chest CPT 71275 • Imaging | $87 | $232 | $379 |
| CT cervical spine without contrast CPT 72125 • Imaging | $49 | $76 | $95 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $42 | $125 | $283 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $84 | $135 | $187 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $71 | $205 | $370 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $30 | $181 | $370 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $72 | $206 | $370 |
| CT pelvis without contrast CPT 72192 • Imaging | $52 | $77 | $103 |
| CT pelvis with contrast CPT 72193 • Imaging | $55 | $113 | $175 |
| X-ray shoulder complete CPT 73030 • Imaging | $17 | $36 | $60 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $42 | $150 | $418 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $24 | $39 | $60 |
| X-ray ankle complete CPT 73610 • Imaging | $17 | $43 | $65 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $42 | $162 | $412 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $208 | $331 | $459 |
| CT abdomen without contrast CPT 74150 • Imaging | $57 | $159 | $273 |
| CT abdomen with contrast CPT 74160 • Imaging | $64 | $196 | $328 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $67 | $215 | $506 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $84 | $186 | $366 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $87 | $168 | $321 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $97 | $254 | $365 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $39 | $113 | $224 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $44 | $70 | $88 |
| Ultrasound transvaginal CPT 76830 • Imaging | $33 | $100 | $224 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $26 | $105 | $181 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $39 | $92 | $147 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $95 | $149 | $213 |
| Screening mammography bilateral CPT 77067 • Imaging | $37 | $130 | $249 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $40 | $54 | $72 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $50 | $194 | $305 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $6 | $16 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $4 | $5 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $4 | $6 | $8 |
| Lipid panel CPT 80061 • Laboratory | $2 | $10 | $25 |
| Hepatic function panel CPT 80076 • Laboratory | $1 | $4 | $7 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $2 | $2 |