| CT head without then with contrast CPT 70470 • Imaging | $93 | $221 | $349 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $41 | $148 | $227 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $82 | $194 | $305 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $66 | $233 | $370 |
| CT angiography neck CPT 70498 • Imaging | $84 | $337 | $542 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $103 | $318 | $488 |
| MRI brain without contrast CPT 70551 • Imaging | $71 | $214 | $280 |
| MRI brain with contrast CPT 70552 • Imaging | $400 | $450 | $475 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $38 | $309 | $667 |
| Chest X-ray single view CPT 71045 • Imaging | $9 | $19 | $30 |
| Chest X-ray 2 views CPT 71046 • Imaging | $11 | $28 | $60 |
| CT chest without contrast CPT 71250 • Imaging | $52 | $153 | $222 |
| CT chest with contrast CPT 71260 • Imaging | $63 | $164 | $359 |
| CT chest without then with contrast CPT 71270 • Imaging | $347 | $386 | $424 |
| CT angiography chest CPT 71275 • Imaging | $133 | $232 | $358 |
| CT cervical spine without contrast CPT 72125 • Imaging | $49 | $154 | $222 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $49 | $121 | $222 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $92 | $186 | $245 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $114 | $288 | $475 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $71 | $223 | $475 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $109 | $264 | $475 |
| CT pelvis without contrast CPT 72192 • Imaging | $52 | $159 | $266 |
| CT pelvis with contrast CPT 72193 • Imaging | $85 | $245 | $336 |
| X-ray shoulder complete CPT 73030 • Imaging | $17 | $30 | $42 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $209 | $270 | $294 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $12 | $34 | $45 |
| X-ray ankle complete CPT 73610 • Imaging | $9 | $32 | $64 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $64 | $144 | $321 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $66 | $257 | $475 |
| CT abdomen without contrast CPT 74150 • Imaging | $115 | $168 | $273 |
| CT abdomen with contrast CPT 74160 • Imaging | $93 | $106 | $118 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $367 | $455 | $510 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $84 | $231 | $366 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $226 | $387 | $598 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $97 | $359 | $491 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $48 | $75 | $116 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $26 | $73 | $207 |
| Ultrasound transvaginal CPT 76830 • Imaging | $33 | $122 | $162 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $42 | $99 | $138 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $114 | $153 | $246 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $74 | $167 | $217 |
| Screening mammography bilateral CPT 77067 • Imaging | $56 | $140 | $251 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $54 | $64 | $74 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $120 | $443 | $872 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $5 | $15 |
| Basic metabolic panel CPT 80048 • Laboratory | $5 | $9 | $10 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $3 | $7 | $12 |
| Lipid panel CPT 80061 • Laboratory | $3 | $10 | $16 |
| Hepatic function panel CPT 80076 • Laboratory | $5 | $8 | $10 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $3 | $4 |