| CT head without then with contrast CPT 70470 • Imaging | $146 | $163 | $181 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $27 | $30 | $33 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $32 | $58 | $84 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $53 | $91 | $129 |
| CT angiography neck CPT 70498 • Imaging | $79 | $152 | $226 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $44 | $128 | $297 |
| MRI brain without contrast CPT 70551 • Imaging | $44 | $51 | $57 |
| MRI brain with contrast CPT 70552 • Imaging | $68 | $289 | $510 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $44 | $161 | $278 |
| Chest X-ray single view CPT 71045 • Imaging | $12 | $15 | $19 |
| Chest X-ray 2 views CPT 71046 • Imaging | $7 | $14 | $18 |
| CT chest without contrast CPT 71250 • Imaging | $44 | $56 | $76 |
| CT chest with contrast CPT 71260 • Imaging | $102 | $137 | $173 |
| CT chest without then with contrast CPT 71270 • Imaging | $41 | $83 | $124 |
| CT angiography chest CPT 71275 • Imaging | $131 | $181 | $231 |
| CT cervical spine without contrast CPT 72125 • Imaging | $45 | $63 | $80 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $119 | $126 | $134 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $67 | $92 | $118 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $57 | $147 | $237 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $57 | $118 | $179 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $57 | $148 | $238 |
| CT pelvis without contrast CPT 72192 • Imaging | $49 | $80 | $111 |
| CT pelvis with contrast CPT 72193 • Imaging | $44 | $92 | $140 |
| X-ray shoulder complete CPT 73030 • Imaging | $7 | $10 | $13 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $76 | $121 | $175 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $7 | $13 | $20 |
| X-ray ankle complete CPT 73610 • Imaging | $6 | $14 | $28 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $196 | $348 | $424 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $52 | $82 | $111 |
| CT abdomen without contrast CPT 74150 • Imaging | $28 | $48 | $68 |
| CT abdomen with contrast CPT 74160 • Imaging | $139 | $159 | $179 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $44 | $128 | $212 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $79 | $117 | $187 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $70 | $158 | $322 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $77 | $267 | $362 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $62 | $78 | $94 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $58 | $72 | $86 |
| Ultrasound transvaginal CPT 76830 • Imaging | $67 | $80 | $92 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $44 | $62 | $84 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $96 | $98 | $102 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $87 | $112 | $129 |
| Screening mammography bilateral CPT 77067 • Imaging | $26 | $42 | $75 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $8 | $18 | $28 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $61 | $213 | $290 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $1 | $2 | $3 |
| Basic metabolic panel CPT 80048 • Laboratory | $2 | $3 | $4 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $1 | $3 | $4 |
| Lipid panel CPT 80061 • Laboratory | $2 | $5 | $7 |
| Hepatic function panel CPT 80076 • Laboratory | $2 | $3 | $4 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $0 | $1 | $2 |