| CT maxillofacial without contrast CPT 70486 • Imaging | $89 | $161 | $233 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $280 | $280 | $280 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $121 | $185 | $250 |
| CT angiography neck CPT 70498 • Imaging | $252 | $298 | $344 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $94 | $312 | $460 |
| MRI brain without contrast CPT 70551 • Imaging | $64 | $197 | $267 |
| MRI brain with contrast CPT 70552 • Imaging | $158 | $352 | $517 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $85 | $270 | $433 |
| Chest X-ray single view CPT 71045 • Imaging | $8 | $25 | $34 |
| Chest X-ray 2 views CPT 71046 • Imaging | $8 | $34 | $55 |
| CT chest without contrast CPT 71250 • Imaging | $47 | $156 | $181 |
| CT chest with contrast CPT 71260 • Imaging | $43 | $120 | $226 |
| CT chest without then with contrast CPT 71270 • Imaging | $120 | $160 | $200 |
| CT angiography chest CPT 71275 • Imaging | $79 | $295 | $349 |
| CT cervical spine without contrast CPT 72125 • Imaging | $48 | $111 | $174 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $48 | $111 | $174 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $48 | $154 | $260 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $55 | $221 | $259 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $65 | $181 | $364 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $56 | $233 | $365 |
| CT pelvis without contrast CPT 72192 • Imaging | $150 | $150 | $150 |
| CT pelvis with contrast CPT 72193 • Imaging | $306 | $355 | $404 |
| X-ray shoulder complete CPT 73030 • Imaging | $8 | $36 | $46 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $30 | $180 | $276 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $15 | $33 | $45 |
| X-ray ankle complete CPT 73610 • Imaging | $8 | $33 | $48 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $50 | $240 | $313 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $60 | $206 | $275 |
| CT abdomen without contrast CPT 74150 • Imaging | $44 | $165 | $251 |
| CT abdomen with contrast CPT 74160 • Imaging | $414 | $414 | $414 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $122 | $146 | $169 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $76 | $195 | $249 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $80 | $352 | $411 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $74 | $349 | $461 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $30 | $140 | $207 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $32 | $104 | $143 |
| Ultrasound transvaginal CPT 76830 • Imaging | $60 | $110 | $157 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $31 | $93 | $139 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $31 | $126 | $166 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $38 | $137 | $209 |
| Screening mammography bilateral CPT 77067 • Imaging | $33 | $139 | $229 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $49 | $49 | $49 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $71 | $471 | $656 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $5 | $12 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $9 | $12 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $4 | $11 | $15 |
| Lipid panel CPT 80061 • Laboratory | $6 | $12 | $19 |
| Hepatic function panel CPT 80076 • Laboratory | $3 | $7 | $12 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $3 | $4 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $4 | $5 |