| CT head without then with contrast CPT 70470 • Imaging | $119 | $148 | $177 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $91 | $105 | $129 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $56 | $67 | $77 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $122 | $173 | $224 |
| CT angiography neck CPT 70498 • Imaging | $62 | $112 | $192 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $30 | $175 | $465 |
| MRI brain without contrast CPT 70551 • Imaging | $30 | $150 | $219 |
| MRI brain with contrast CPT 70552 • Imaging | $276 | $285 | $303 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $30 | $184 | $358 |
| Chest X-ray single view CPT 71045 • Imaging | $15 | $18 | $22 |
| Chest X-ray 2 views CPT 71046 • Imaging | $17 | $24 | $29 |
| CT chest without contrast CPT 71250 • Imaging | $27 | $80 | $134 |
| CT chest with contrast CPT 71260 • Imaging | $34 | $87 | $217 |
| CT chest without then with contrast CPT 71270 • Imaging | $60 | $160 | $261 |
| CT angiography chest CPT 71275 • Imaging | $64 | $150 | $255 |
| CT cervical spine without contrast CPT 72125 • Imaging | $35 | $80 | $122 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $35 | $72 | $131 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $35 | $72 | $131 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $125 | $153 | $195 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $195 | $201 | $213 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $30 | $121 | $196 |
| CT pelvis without contrast CPT 72192 • Imaging | $51 | $63 | $85 |
| CT pelvis with contrast CPT 72193 • Imaging | $55 | $135 | $214 |
| X-ray shoulder complete CPT 73030 • Imaging | $15 | $24 | $32 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $41 | $135 | $206 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $15 | $22 | $29 |
| X-ray ankle complete CPT 73610 • Imaging | $6 | $14 | $22 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $165 | $255 | $344 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $48 | $139 | $224 |
| CT abdomen without contrast CPT 74150 • Imaging | $59 | $112 | $139 |
| CT abdomen with contrast CPT 74160 • Imaging | $169 | $194 | $219 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $70 | $128 | $169 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $77 | $134 | $192 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $65 | $195 | $313 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $335 | $345 | $351 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $21 | $67 | $103 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $32 | $61 | $96 |
| Ultrasound transvaginal CPT 76830 • Imaging | $25 | $79 | $106 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $30 | $31 | $34 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $39 | $79 | $110 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $113 | $127 | $139 |
| Screening mammography bilateral CPT 77067 • Imaging | $27 | $32 | $37 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $10 | $24 | $32 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $68 | $142 | $322 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $3 | $5 |
| Basic metabolic panel CPT 80048 • Laboratory | $3 | $5 | $6 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $2 | $4 | $6 |
| Lipid panel CPT 80061 • Laboratory | $4 | $8 | $11 |
| Hepatic function panel CPT 80076 • Laboratory | $3 | $4 | $5 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $2 | $3 |