| CT maxillofacial without contrast CPT 70486 • Imaging | $137 | $143 | $149 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $61 | $61 | $61 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $142 | $175 | $209 |
| CT angiography neck CPT 70498 • Imaging | $222 | $258 | $293 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $361 | $388 | $415 |
| MRI brain without contrast CPT 70551 • Imaging | $80 | $151 | $223 |
| MRI brain with contrast CPT 70552 • Imaging | $96 | $96 | $96 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $339 | $364 | $389 |
| Chest X-ray single view CPT 71045 • Imaging | $17 | $22 | $27 |
| Chest X-ray 2 views CPT 71046 • Imaging | $12 | $12 | $12 |
| CT chest without contrast CPT 71250 • Imaging | $141 | $155 | $169 |
| CT chest with contrast CPT 71260 • Imaging | $209 | $209 | $209 |
| CT chest without then with contrast CPT 71270 • Imaging | $174 | $192 | $210 |
| CT angiography chest CPT 71275 • Imaging | $225 | $225 | $225 |
| CT cervical spine without contrast CPT 72125 • Imaging | $54 | $97 | $139 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $54 | $96 | $139 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $54 | $96 | $139 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $152 | $177 | $203 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $80 | $141 | $203 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $73 | $112 | $152 |
| CT pelvis without contrast CPT 72192 • Imaging | $155 | $155 | $155 |
| CT pelvis with contrast CPT 72193 • Imaging | $258 | $259 | $260 |
| X-ray shoulder complete CPT 73030 • Imaging | $35 | $36 | $38 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $74 | $74 | $74 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $32 | $34 | $37 |
| X-ray ankle complete CPT 73610 • Imaging | $9 | $27 | $32 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $202 | $202 | $202 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $219 | $231 | $244 |
| CT abdomen without contrast CPT 74150 • Imaging | $64 | $104 | $145 |
| CT abdomen with contrast CPT 74160 • Imaging | $264 | $264 | $264 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $278 | $288 | $297 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $120 | $120 | $120 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $345 | $347 | $349 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $388 | $390 | $392 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $131 | $131 | $131 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $39 | $76 | $114 |
| Ultrasound transvaginal CPT 76830 • Imaging | $37 | $37 | $37 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $117 | $117 | $117 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $44 | $88 | $133 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $54 | $54 | $54 |
| Screening mammography bilateral CPT 77067 • Imaging | $41 | $88 | $135 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $42 | $42 | $42 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $85 | $274 | $462 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $6 | $9 |
| Basic metabolic panel CPT 80048 • Laboratory | $5 | $7 | $8 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $6 | $6 | $6 |
| Lipid panel CPT 80061 • Laboratory | $8 | $11 | $13 |
| Hepatic function panel CPT 80076 • Laboratory | $5 | $7 | $8 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $3 | $4 | $4 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $3 | $4 | $4 |