| CT head with contrast CPT 70460 • Imaging | $179 | $194 | $209 |
| CT head without then with contrast CPT 70470 • Imaging | $71 | $71 | $71 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $63 | $108 | $154 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $72 | $72 | $72 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $223 | $274 | $325 |
| CT angiography neck CPT 70498 • Imaging | $300 | $491 | $682 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $119 | $275 | $415 |
| MRI brain without contrast CPT 70551 • Imaging | $154 | $284 | $543 |
| MRI brain with contrast CPT 70552 • Imaging | $99 | $214 | $328 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $126 | $433 | $785 |
| Chest X-ray single view CPT 71045 • Imaging | $12 | $23 | $30 |
| Chest X-ray 2 views CPT 71046 • Imaging | $12 | $12 | $12 |
| CT chest without contrast CPT 71250 • Imaging | $99 | $136 | $209 |
| CT chest with contrast CPT 71260 • Imaging | $64 | $162 | $259 |
| CT chest without then with contrast CPT 71270 • Imaging | $77 | $158 | $238 |
| CT angiography chest CPT 71275 • Imaging | $340 | $439 | $538 |
| CT cervical spine without contrast CPT 72125 • Imaging | $157 | $216 | $275 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $156 | $215 | $274 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $156 | $182 | $209 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $89 | $184 | $233 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $232 | $361 | $504 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $82 | $133 | $233 |
| CT pelvis without contrast CPT 72192 • Imaging | $61 | $61 | $61 |
| CT pelvis with contrast CPT 72193 • Imaging | $267 | $289 | $311 |
| X-ray shoulder complete CPT 73030 • Imaging | $11 | $19 | $36 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $75 | $123 | $171 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $9 | $22 | $36 |
| X-ray ankle complete CPT 73610 • Imaging | $10 | $27 | $38 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $271 | $364 | $457 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $245 | $353 | $446 |
| CT abdomen without contrast CPT 74150 • Imaging | $99 | $176 | $263 |
| CT abdomen with contrast CPT 74160 • Imaging | $71 | $71 | $71 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $78 | $180 | $281 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $96 | $208 | $293 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $289 | $389 | $459 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $412 | $497 | $581 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $144 | $175 | $206 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $114 | $126 | $137 |
| Ultrasound transvaginal CPT 76830 • Imaging | $38 | $64 | $89 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $38 | $81 | $124 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $50 | $95 | $131 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $55 | $59 | $62 |
| Screening mammography bilateral CPT 77067 • Imaging | $47 | $97 | $134 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $10 | $10 | $10 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $111 | $434 | $608 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $2 | $3 |
| Basic metabolic panel CPT 80048 • Laboratory | $5 | $6 | $8 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $5 | $6 | $6 |
| Lipid panel CPT 80061 • Laboratory | $8 | $10 | $13 |
| Hepatic function panel CPT 80076 • Laboratory | $4 | $6 | $8 |