| CT maxillofacial without contrast CPT 70486 • Imaging | $249 | $249 | $249 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $235 | $235 | $235 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $70 | $70 | $70 |
| CT angiography neck CPT 70498 • Imaging | $531 | $531 | $531 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $495 | $617 | $719 |
| MRI brain without contrast CPT 70551 • Imaging | $75 | $231 | $309 |
| MRI brain with contrast CPT 70552 • Imaging | $420 | $464 | $552 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $496 | $529 | $594 |
| Chest X-ray single view CPT 71045 • Imaging | $11 | $11 | $11 |
| Chest X-ray 2 views CPT 71046 • Imaging | $31 | $31 | $31 |
| CT chest without contrast CPT 71250 • Imaging | $174 | $202 | $241 |
| CT chest with contrast CPT 71260 • Imaging | $220 | $252 | $302 |
| CT chest without then with contrast CPT 71270 • Imaging | $367 | $367 | $367 |
| CT angiography chest CPT 71275 • Imaging | $97 | $346 | $470 |
| CT cervical spine without contrast CPT 72125 • Imaging | $191 | $191 | $191 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $59 | $59 | $59 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $249 | $249 | $249 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $307 | $328 | $369 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $98 | $261 | $378 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $307 | $331 | $377 |
| CT pelvis without contrast CPT 72192 • Imaging | $236 | $236 | $236 |
| CT pelvis with contrast CPT 72193 • Imaging | $224 | $224 | $224 |
| X-ray shoulder complete CPT 73030 • Imaging | $28 | $36 | $40 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $90 | $292 | $466 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $28 | $35 | $39 |
| X-ray ankle complete CPT 73610 • Imaging | $30 | $35 | $43 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $68 | $330 | $461 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $68 | $207 | $321 |
| CT abdomen without contrast CPT 74150 • Imaging | $196 | $210 | $239 |
| CT abdomen with contrast CPT 74160 • Imaging | $64 | $64 | $64 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $71 | $71 | $71 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $227 | $259 | $275 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $94 | $304 | $409 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $347 | $433 | $476 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $41 | $133 | $178 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $37 | $124 | $168 |
| Ultrasound transvaginal CPT 76830 • Imaging | $115 | $145 | $160 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $81 | $132 | $157 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $94 | $94 | $94 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $120 | $120 | $120 |
| Screening mammography bilateral CPT 77067 • Imaging | $99 | $99 | $99 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $82 | $82 | $82 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $434 | $548 | $604 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $3 | $4 |
| Basic metabolic panel CPT 80048 • Laboratory | $6 | $7 | $8 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $6 | $7 | $8 |
| Lipid panel CPT 80061 • Laboratory | $8 | $9 | $10 |
| Hepatic function panel CPT 80076 • Laboratory | $6 | $7 | $8 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $3 | $3 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $2 | $3 |