| CT head without then with contrast CPT 70470 • Imaging | $45 | $223 | $401 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $93 | $107 | $120 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $51 | $87 | $123 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $122 | $136 | $151 |
| CT angiography neck CPT 70498 • Imaging | $120 | $370 | $620 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $247 | $392 | $581 |
| MRI brain without contrast CPT 70551 • Imaging | $45 | $140 | $305 |
| MRI brain with contrast CPT 70552 • Imaging | $125 | $198 | $276 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $109 | $317 | $514 |
| Chest X-ray single view CPT 71045 • Imaging | $8 | $25 | $54 |
| Chest X-ray 2 views CPT 71046 • Imaging | $9 | $33 | $68 |
| CT chest without contrast CPT 71250 • Imaging | $34 | $108 | $206 |
| CT chest with contrast CPT 71260 • Imaging | $34 | $159 | $275 |
| CT chest without then with contrast CPT 71270 • Imaging | $34 | $185 | $336 |
| CT angiography chest CPT 71275 • Imaging | $169 | $208 | $256 |
| CT cervical spine without contrast CPT 72125 • Imaging | $84 | $205 | $326 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $86 | $97 | $109 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $131 | $173 | $215 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $125 | $258 | $455 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $63 | $112 | $162 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $71 | $241 | $456 |
| CT pelvis without contrast CPT 72192 • Imaging | $83 | $194 | $305 |
| CT pelvis with contrast CPT 72193 • Imaging | $120 | $249 | $379 |
| X-ray shoulder complete CPT 73030 • Imaging | $5 | $16 | $23 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $50 | $149 | $331 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $23 | $38 | $70 |
| X-ray ankle complete CPT 73610 • Imaging | $19 | $32 | $53 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $45 | $85 | $147 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $141 | $205 | $331 |
| CT abdomen without contrast CPT 74150 • Imaging | $34 | $162 | $314 |
| CT abdomen with contrast CPT 74160 • Imaging | $230 | $373 | $516 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $171 | $376 | $582 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $171 | $191 | $232 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $171 | $360 | $684 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $95 | $345 | $768 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $35 | $53 | $89 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $75 | $84 | $96 |
| Ultrasound transvaginal CPT 76830 • Imaging | $23 | $60 | $83 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $30 | $79 | $155 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $35 | $89 | $192 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $43 | $191 | $354 |
| Screening mammography bilateral CPT 77067 • Imaging | $32 | $119 | $286 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $7 | $34 | $61 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $68 | $376 | $992 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $3 | $3 |
| Basic metabolic panel CPT 80048 • Laboratory | $6 | $7 | $9 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $8 | $9 | $12 |
| Lipid panel CPT 80061 • Laboratory | $2 | $9 | $15 |
| Hepatic function panel CPT 80076 • Laboratory | $7 | $8 | $9 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $2 | $3 |