| CT soft tissue neck with contrast CPT 70491 • Imaging | $252 | $270 | $288 |
| CT angiography neck CPT 70498 • Imaging | $590 | $590 | $590 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $256 | $631 | $1,049 |
| MRI brain without contrast CPT 70551 • Imaging | $70 | $420 | $944 |
| MRI brain with contrast CPT 70552 • Imaging | $100 | $445 | $719 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $159 | $645 | $1,059 |
| Chest X-ray single view CPT 71045 • Imaging | $11 | $27 | $58 |
| Chest X-ray 2 views CPT 71046 • Imaging | $14 | $43 | $75 |
| CT chest without contrast CPT 71250 • Imaging | $74 | $208 | $348 |
| CT chest with contrast CPT 71260 • Imaging | $175 | $312 | $438 |
| CT chest without then with contrast CPT 71270 • Imaging | $285 | $382 | $479 |
| CT angiography chest CPT 71275 • Imaging | $279 | $503 | $663 |
| CT cervical spine without contrast CPT 72125 • Imaging | $65 | $65 | $65 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $65 | $65 | $65 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $261 | $261 | $261 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $89 | $423 | $944 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $89 | $406 | $944 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $75 | $380 | $944 |
| CT pelvis without contrast CPT 72192 • Imaging | $314 | $314 | $314 |
| CT pelvis with contrast CPT 72193 • Imaging | $305 | $306 | $306 |
| X-ray shoulder complete CPT 73030 • Imaging | $9 | $40 | $77 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $75 | $328 | $599 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $32 | $45 | $77 |
| X-ray ankle complete CPT 73610 • Imaging | $10 | $38 | $83 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $64 | $311 | $578 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $94 | $397 | $944 |
| CT abdomen without contrast CPT 74150 • Imaging | $56 | $248 | $359 |
| CT abdomen with contrast CPT 74160 • Imaging | $403 | $403 | $403 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $438 | $438 | $438 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $83 | $252 | $478 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $87 | $422 | $817 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $127 | $510 | $915 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $45 | $136 | $264 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $41 | $123 | $245 |
| Ultrasound transvaginal CPT 76830 • Imaging | $30 | $129 | $271 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $33 | $113 | $239 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $56 | $131 | $282 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $44 | $137 | $356 |
| Screening mammography bilateral CPT 77067 • Imaging | $37 | $146 | $287 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $10 | $10 | $10 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $110 | $608 | $1,095 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $10 | $14 |
| Basic metabolic panel CPT 80048 • Laboratory | $5 | $9 | $14 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $5 | $12 | $19 |
| Lipid panel CPT 80061 • Laboratory | $9 | $17 | $32 |
| Hepatic function panel CPT 80076 • Laboratory | $4 | $8 | $12 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $4 | $5 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $4 | $7 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $2 | $3 | $5 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $8 | $21 | $30 |