| CT head without then with contrast CPT 70470 • Imaging | $86 | $95 | $110 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $44 | $80 | $120 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $44 | $89 | $146 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $44 | $72 | $120 |
| CT angiography neck CPT 70498 • Imaging | $44 | $453 | $1,165 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $174 | $344 | $643 |
| MRI brain without contrast CPT 70551 • Imaging | $170 | $181 | $191 |
| MRI brain with contrast CPT 70552 • Imaging | $78 | $236 | $510 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $300 | $440 | $692 |
| Chest X-ray single view CPT 71045 • Imaging | $6 | $33 | $54 |
| Chest X-ray 2 views CPT 71046 • Imaging | $17 | $34 | $48 |
| CT chest without contrast CPT 71250 • Imaging | $44 | $105 | $137 |
| CT chest with contrast CPT 71260 • Imaging | $108 | $126 | $149 |
| CT chest without then with contrast CPT 71270 • Imaging | $60 | $81 | $103 |
| CT angiography chest CPT 71275 • Imaging | $84 | $141 | $179 |
| CT cervical spine without contrast CPT 72125 • Imaging | $44 | $155 | $353 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $44 | $83 | $138 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $27 | $77 | $114 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $44 | $141 | $196 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $44 | $189 | $358 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $72 | $118 | $159 |
| CT pelvis without contrast CPT 72192 • Imaging | $42 | $65 | $88 |
| CT pelvis with contrast CPT 72193 • Imaging | $44 | $92 | $153 |
| X-ray shoulder complete CPT 73030 • Imaging | $8 | $29 | $66 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $44 | $254 | $641 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $11 | $28 | $44 |
| X-ray ankle complete CPT 73610 • Imaging | $12 | $31 | $63 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $212 | $286 | $424 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $44 | $142 | $204 |
| CT abdomen without contrast CPT 74150 • Imaging | $51 | $53 | $54 |
| CT abdomen with contrast CPT 74160 • Imaging | $47 | $101 | $167 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $49 | $131 | $212 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $154 | $212 | $321 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $83 | $163 | $322 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $91 | $380 | $687 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $90 | $106 | $135 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $25 | $35 | $50 |
| Ultrasound transvaginal CPT 76830 • Imaging | $18 | $36 | $61 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $16 | $38 | $61 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $28 | $108 | $234 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $35 | $75 | $121 |
| Screening mammography bilateral CPT 77067 • Imaging | $26 | $67 | $104 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $7 | $9 | $14 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $110 | $293 | $428 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $7 | $17 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $4 | $5 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $1 | $6 | $12 |
| Lipid panel CPT 80061 • Laboratory | $4 | $10 | $24 |
| Hepatic function panel CPT 80076 • Laboratory | $2 | $4 | $5 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $0 | $3 | $6 |