| CT head without then with contrast CPT 70470 • Imaging | $54 | $71 | $88 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $66 | $90 | $113 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $48 | $49 | $51 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $165 | $177 | $188 |
| CT angiography neck CPT 70498 • Imaging | $149 | $158 | $167 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $30 | $173 | $317 |
| MRI brain without contrast CPT 70551 • Imaging | $171 | $174 | $182 |
| MRI brain with contrast CPT 70552 • Imaging | $145 | $160 | $176 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $185 | $233 | $297 |
| Chest X-ray single view CPT 71045 • Imaging | $6 | $17 | $25 |
| Chest X-ray 2 views CPT 71046 • Imaging | $9 | $24 | $32 |
| CT chest without contrast CPT 71250 • Imaging | $44 | $54 | $69 |
| CT chest with contrast CPT 71260 • Imaging | $53 | $100 | $146 |
| CT chest without then with contrast CPT 71270 • Imaging | $57 | $58 | $58 |
| CT angiography chest CPT 71275 • Imaging | $77 | $128 | $221 |
| CT cervical spine without contrast CPT 72125 • Imaging | $26 | $55 | $84 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $42 | $66 | $89 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $74 | $79 | $84 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $125 | $156 | $177 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $114 | $140 | $166 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $63 | $132 | $167 |
| CT pelvis without contrast CPT 72192 • Imaging | $27 | $73 | $119 |
| CT pelvis with contrast CPT 72193 • Imaging | $49 | $140 | $232 |
| X-ray shoulder complete CPT 73030 • Imaging | $19 | $28 | $44 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $53 | $91 | $129 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $7 | $15 | $22 |
| X-ray ankle complete CPT 73610 • Imaging | $6 | $14 | $28 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $30 | $221 | $424 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $111 | $149 | $206 |
| CT abdomen without contrast CPT 74150 • Imaging | $47 | $96 | $122 |
| CT abdomen with contrast CPT 74160 • Imaging | $44 | $49 | $54 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $226 | $235 | $243 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $68 | $130 | $164 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $77 | $224 | $323 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $95 | $233 | $305 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $35 | $55 | $77 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $22 | $42 | $71 |
| Ultrasound transvaginal CPT 76830 • Imaging | $21 | $67 | $100 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $81 | $91 | $103 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $28 | $62 | $82 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $30 | $77 | $104 |
| Screening mammography bilateral CPT 77067 • Imaging | $32 | $54 | $98 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $8 | $20 | $32 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $245 | $307 | $386 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $1 | $1 | $2 |
| Basic metabolic panel CPT 80048 • Laboratory | $1 | $4 | $7 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $6 | $7 | $8 |
| Lipid panel CPT 80061 • Laboratory | $2 | $7 | $12 |
| Hepatic function panel CPT 80076 • Laboratory | $5 | $5 | $7 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $3 | $3 |