| CT head without then with contrast CPT 70470 • Imaging | $94 | $109 | $120 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $51 | $63 | $76 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $45 | $100 | $156 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $86 | $103 | $123 |
| CT angiography neck CPT 70498 • Imaging | $120 | $134 | $154 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $125 | $285 | $574 |
| MRI brain without contrast CPT 70551 • Imaging | $131 | $288 | $504 |
| MRI brain with contrast CPT 70552 • Imaging | $63 | $297 | $696 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $125 | $187 | $250 |
| Chest X-ray single view CPT 71045 • Imaging | $8 | $15 | $18 |
| Chest X-ray 2 views CPT 71046 • Imaging | $18 | $25 | $43 |
| CT chest without contrast CPT 71250 • Imaging | $28 | $49 | $86 |
| CT chest with contrast CPT 71260 • Imaging | $91 | $121 | $169 |
| CT chest without then with contrast CPT 71270 • Imaging | $171 | $202 | $233 |
| CT angiography chest CPT 71275 • Imaging | $34 | $282 | $644 |
| CT cervical spine without contrast CPT 72125 • Imaging | $34 | $129 | $262 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $45 | $106 | $182 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $86 | $118 | $181 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $125 | $240 | $493 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $109 | $170 | $250 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $109 | $246 | $494 |
| CT pelvis without contrast CPT 72192 • Imaging | $80 | $104 | $135 |
| CT pelvis with contrast CPT 72193 • Imaging | $86 | $170 | $320 |
| X-ray shoulder complete CPT 73030 • Imaging | $14 | $29 | $45 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $100 | $249 | $521 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $15 | $26 | $44 |
| X-ray ankle complete CPT 73610 • Imaging | $5 | $24 | $32 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $120 | $223 | $336 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $50 | $156 | $356 |
| CT abdomen without contrast CPT 74150 • Imaging | $45 | $147 | $351 |
| CT abdomen with contrast CPT 74160 • Imaging | $51 | $72 | $94 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $171 | $220 | $269 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $69 | $236 | $468 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $171 | $360 | $790 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $190 | $458 | $884 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $16 | $77 | $116 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $64 | $84 | $108 |
| Ultrasound transvaginal CPT 76830 • Imaging | $30 | $43 | $62 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $47 | $90 | $158 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $73 | $119 | $192 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $74 | $110 | $139 |
| Screening mammography bilateral CPT 77067 • Imaging | $39 | $100 | $196 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $9 | $14 | $18 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $117 | $487 | $1,095 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $6 | $14 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $8 | $14 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $2 | $5 | $9 |
| Lipid panel CPT 80061 • Laboratory | $2 | $11 | $22 |
| Hepatic function panel CPT 80076 • Laboratory | $4 | $6 | $11 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $3 | $5 |