| CT soft tissue neck with contrast CPT 70491 • Imaging | $63 | $204 | $345 |
| CT angiography neck CPT 70498 • Imaging | $263 | $263 | $263 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $355 | $450 | $623 |
| MRI brain without contrast CPT 70551 • Imaging | $140 | $413 | $504 |
| MRI brain with contrast CPT 70552 • Imaging | $295 | $434 | $504 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $103 | $284 | $582 |
| Chest X-ray single view CPT 71045 • Imaging | $9 | $39 | $55 |
| Chest X-ray 2 views CPT 71046 • Imaging | $11 | $35 | $61 |
| CT chest without contrast CPT 71250 • Imaging | $152 | $242 | $272 |
| CT chest with contrast CPT 71260 • Imaging | $62 | $252 | $347 |
| CT chest without then with contrast CPT 71270 • Imaging | $222 | $325 | $427 |
| CT angiography chest CPT 71275 • Imaging | $91 | $352 | $483 |
| CT cervical spine without contrast CPT 72125 • Imaging | $353 | $353 | $353 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $351 | $351 | $351 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $92 | $92 | $92 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $193 | $426 | $504 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $109 | $269 | $504 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $135 | $381 | $504 |
| CT pelvis without contrast CPT 72192 • Imaging | $128 | $128 | $128 |
| CT pelvis with contrast CPT 72193 • Imaging | $214 | $318 | $422 |
| X-ray shoulder complete CPT 73030 • Imaging | $22 | $55 | $67 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $148 | $371 | $504 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $22 | $50 | $64 |
| X-ray ankle complete CPT 73610 • Imaging | $9 | $44 | $69 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $61 | $356 | $504 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $219 | $401 | $504 |
| CT abdomen without contrast CPT 74150 • Imaging | $54 | $200 | $274 |
| CT abdomen with contrast CPT 74160 • Imaging | $57 | $57 | $57 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $64 | $64 | $64 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $87 | $248 | $329 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $91 | $440 | $557 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $322 | $551 | $627 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $108 | $176 | $210 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $66 | $152 | $195 |
| Ultrasound transvaginal CPT 76830 • Imaging | $84 | $173 | $218 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $31 | $92 | $194 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $41 | $167 | $229 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $290 | $336 | $427 |
| Screening mammography bilateral CPT 77067 • Imaging | $97 | $186 | $234 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $47 | $47 | $47 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $120 | $426 | $810 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $1 | $6 | $13 |
| Basic metabolic panel CPT 80048 • Laboratory | $11 | $11 | $12 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $12 | $14 | $15 |
| Lipid panel CPT 80061 • Laboratory | $6 | $15 | $19 |
| Hepatic function panel CPT 80076 • Laboratory | $10 | $11 | $11 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $4 | $4 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $4 | $5 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $1 | $2 | $3 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $10 | $19 | $22 |