| CT head without then with contrast CPT 70470 • Imaging | $238 | $238 | $238 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $229 | $229 | $229 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $276 | $276 | $276 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $216 | $216 | $216 |
| CT angiography neck CPT 70498 • Imaging | $517 | $517 | $517 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $697 | $899 | $1,101 |
| MRI brain without contrast CPT 70551 • Imaging | $82 | $277 | $472 |
| MRI brain with contrast CPT 70552 • Imaging | $75 | $306 | $537 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $695 | $845 | $994 |
| Chest X-ray single view CPT 71045 • Imaging | $9 | $16 | $22 |
| Chest X-ray 2 views CPT 71046 • Imaging | $10 | $22 | $34 |
| CT chest without contrast CPT 71250 • Imaging | $196 | $248 | $301 |
| CT chest with contrast CPT 71260 • Imaging | $240 | $296 | $352 |
| CT chest without then with contrast CPT 71270 • Imaging | $359 | $359 | $359 |
| CT angiography chest CPT 71275 • Imaging | $460 | $527 | $595 |
| CT cervical spine without contrast CPT 72125 • Imaging | $196 | $196 | $196 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $48 | $48 | $48 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $196 | $196 | $196 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $89 | $267 | $445 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $400 | $493 | $586 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $399 | $489 | $579 |
| CT pelvis without contrast CPT 72192 • Imaging | $46 | $46 | $46 |
| CT pelvis with contrast CPT 72193 • Imaging | $49 | $49 | $49 |
| X-ray shoulder complete CPT 73030 • Imaging | $23 | $24 | $26 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $449 | $483 | $517 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $7 | $8 | $10 |
| X-ray ankle complete CPT 73610 • Imaging | $26 | $28 | $31 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $56 | $66 | $75 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $398 | $420 | $442 |
| CT abdomen without contrast CPT 74150 • Imaging | $50 | $171 | $292 |
| CT abdomen with contrast CPT 74160 • Imaging | $249 | $249 | $249 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $59 | $59 | $59 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $123 | $136 | $150 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $86 | $186 | $285 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $96 | $294 | $493 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $79 | $95 | $111 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $31 | $55 | $79 |
| Ultrasound transvaginal CPT 76830 • Imaging | $38 | $67 | $95 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $29 | $64 | $100 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $37 | $69 | $102 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $46 | $116 | $186 |
| Screening mammography bilateral CPT 77067 • Imaging | $88 | $98 | $108 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $9 | $9 | $9 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $103 | $244 | $386 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $2 | $3 |
| Basic metabolic panel CPT 80048 • Laboratory | $6 | $7 | $9 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $6 | $6 | $7 |
| Lipid panel CPT 80061 • Laboratory | $5 | $7 | $9 |
| Hepatic function panel CPT 80076 • Laboratory | $5 | $5 | $6 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $3 | $3 | $3 |