| CT angiography neck CPT 70498 • Imaging | $155 | $206 | $252 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $132 | $448 | $978 |
| MRI brain without contrast CPT 70551 • Imaging | $89 | $252 | $700 |
| MRI brain with contrast CPT 70552 • Imaging | $107 | $330 | $751 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $109 | $321 | $738 |
| Chest X-ray single view CPT 71045 • Imaging | $13 | $24 | $44 |
| Chest X-ray 2 views CPT 71046 • Imaging | $16 | $35 | $57 |
| CT chest without contrast CPT 71250 • Imaging | $74 | $180 | $382 |
| CT chest with contrast CPT 71260 • Imaging | $30 | $177 | $538 |
| CT chest without then with contrast CPT 71270 • Imaging | $165 | $183 | $200 |
| CT angiography chest CPT 71275 • Imaging | $45 | $225 | $348 |
| CT cervical spine without contrast CPT 72125 • Imaging | $48 | $75 | $90 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $48 | $83 | $112 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $48 | $132 | $260 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $89 | $229 | $490 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $45 | $167 | $291 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $131 | $238 | $490 |
| CT pelvis without contrast CPT 72192 • Imaging | $50 | $73 | $96 |
| CT pelvis with contrast CPT 72193 • Imaging | $103 | $216 | $306 |
| X-ray shoulder complete CPT 73030 • Imaging | $8 | $27 | $46 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $82 | $234 | $490 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $23 | $41 | $63 |
| X-ray ankle complete CPT 73610 • Imaging | $12 | $37 | $67 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $72 | $285 | $684 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $84 | $228 | $555 |
| CT abdomen without contrast CPT 74150 • Imaging | $65 | $143 | $350 |
| CT abdomen with contrast CPT 74160 • Imaging | $251 | $251 | $251 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $72 | $120 | $169 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $69 | $194 | $317 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $159 | $355 | $514 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $123 | $380 | $829 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $61 | $132 | $289 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $64 | $126 | $267 |
| Ultrasound transvaginal CPT 76830 • Imaging | $67 | $144 | $243 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $30 | $112 | $218 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $37 | $151 | $312 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $46 | $185 | $396 |
| Screening mammography bilateral CPT 77067 • Imaging | $47 | $120 | $320 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $18 | $30 | $42 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $68 | $479 | $701 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $5 | $12 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $9 | $16 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $4 | $11 | $20 |
| Lipid panel CPT 80061 • Laboratory | $6 | $17 | $53 |
| Hepatic function panel CPT 80076 • Laboratory | $4 | $8 | $15 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $3 | $7 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $4 | $6 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $1 | $3 | $5 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $8 | $18 | $33 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $17 | $34 | $55 |