| CT head without then with contrast CPT 70470 • Imaging | $86 | $90 | $94 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $30 | $61 | $77 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $41 | $60 | $78 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $30 | $170 | $359 |
| CT angiography neck CPT 70498 • Imaging | $30 | $82 | $152 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $30 | $288 | $690 |
| MRI brain without contrast CPT 70551 • Imaging | $40 | $189 | $396 |
| MRI brain with contrast CPT 70552 • Imaging | $121 | $194 | $267 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $30 | $344 | $692 |
| Chest X-ray single view CPT 71045 • Imaging | $16 | $44 | $55 |
| Chest X-ray 2 views CPT 71046 • Imaging | $9 | $32 | $58 |
| CT chest without contrast CPT 71250 • Imaging | $30 | $87 | $134 |
| CT chest with contrast CPT 71260 • Imaging | $110 | $130 | $168 |
| CT chest without then with contrast CPT 71270 • Imaging | $30 | $72 | $113 |
| CT angiography chest CPT 71275 • Imaging | $80 | $185 | $290 |
| CT cervical spine without contrast CPT 72125 • Imaging | $30 | $205 | $493 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $30 | $69 | $91 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $30 | $83 | $114 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $30 | $116 | $183 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $30 | $166 | $252 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $30 | $135 | $188 |
| CT pelvis without contrast CPT 72192 • Imaging | $95 | $128 | $161 |
| CT pelvis with contrast CPT 72193 • Imaging | $30 | $121 | $231 |
| X-ray shoulder complete CPT 73030 • Imaging | $9 | $22 | $30 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $30 | $78 | $119 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $21 | $42 | $85 |
| X-ray ankle complete CPT 73610 • Imaging | $22 | $36 | $59 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $59 | $88 | $117 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $30 | $132 | $206 |
| CT abdomen without contrast CPT 74150 • Imaging | $30 | $107 | $187 |
| CT abdomen with contrast CPT 74160 • Imaging | $88 | $101 | $114 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $30 | $174 | $369 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $154 | $165 | $185 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $161 | $342 | $580 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $176 | $270 | $351 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $103 | $152 | $219 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $30 | $51 | $65 |
| Ultrasound transvaginal CPT 76830 • Imaging | $62 | $110 | $164 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $95 | $121 | $146 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $72 | $105 | $129 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $89 | $120 | $139 |
| Screening mammography bilateral CPT 77067 • Imaging | $28 | $60 | $112 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $17 | $21 | $24 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $69 | $240 | $391 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $3 | $3 |
| Basic metabolic panel CPT 80048 • Laboratory | $5 | $8 | $11 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $6 | $9 | $12 |
| Lipid panel CPT 80061 • Laboratory | $11 | $16 | $19 |
| Hepatic function panel CPT 80076 • Laboratory | $3 | $7 | $11 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $3 | $6 |