| CT maxillofacial without contrast CPT 70486 • Imaging | $75 | $135 | $242 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $82 | $181 | $280 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $220 | $272 | $346 |
| CT angiography neck CPT 70498 • Imaging | $127 | $178 | $238 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $247 | $471 | $652 |
| MRI brain without contrast CPT 70551 • Imaging | $130 | $241 | $369 |
| MRI brain with contrast CPT 70552 • Imaging | $233 | $233 | $233 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $197 | $271 | $327 |
| Chest X-ray single view CPT 71045 • Imaging | $13 | $22 | $34 |
| Chest X-ray 2 views CPT 71046 • Imaging | $16 | $28 | $44 |
| CT chest without contrast CPT 71250 • Imaging | $71 | $130 | $181 |
| CT chest with contrast CPT 71260 • Imaging | $47 | $120 | $226 |
| CT chest without then with contrast CPT 71270 • Imaging | $169 | $185 | $200 |
| CT angiography chest CPT 71275 • Imaging | $133 | $330 | $508 |
| CT cervical spine without contrast CPT 72125 • Imaging | $48 | $98 | $174 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $72 | $92 | $131 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $48 | $69 | $87 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $109 | $216 | $259 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $30 | $116 | $195 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $59 | $125 | $260 |
| CT pelvis without contrast CPT 72192 • Imaging | $80 | $162 | $244 |
| CT pelvis with contrast CPT 72193 • Imaging | $85 | $197 | $306 |
| X-ray shoulder complete CPT 73030 • Imaging | $22 | $44 | $71 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $54 | $131 | $207 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $7 | $30 | $56 |
| X-ray ankle complete CPT 73610 • Imaging | $11 | $34 | $48 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $98 | $277 | $431 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $99 | $192 | $275 |
| CT abdomen without contrast CPT 74150 • Imaging | $87 | $140 | $186 |
| CT abdomen with contrast CPT 74160 • Imaging | $51 | $72 | $93 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $103 | $154 | $236 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $128 | $178 | $249 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $73 | $257 | $411 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $215 | $443 | $637 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $59 | $95 | $154 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $96 | $157 | $200 |
| Ultrasound transvaginal CPT 76830 • Imaging | $108 | $162 | $221 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $44 | $52 | $60 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $35 | $88 | $166 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $144 | $183 | $209 |
| Screening mammography bilateral CPT 77067 • Imaging | $49 | $87 | $119 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $49 | $61 | $74 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $120 | $321 | $467 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $5 | $15 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $9 | $12 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $2 | $8 | $15 |
| Lipid panel CPT 80061 • Laboratory | $3 | $8 | $11 |
| Hepatic function panel CPT 80076 • Laboratory | $3 | $6 | $7 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $3 | $4 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $3 | $4 | $5 |