| CT maxillofacial without contrast CPT 70486 • Imaging | $118 | $232 | $346 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $134 | $134 | $134 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $344 | $443 | $542 |
| CT angiography neck CPT 70498 • Imaging | $180 | $336 | $492 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $44 | $493 | $853 |
| MRI brain without contrast CPT 70551 • Imaging | $64 | $389 | $621 |
| MRI brain with contrast CPT 70552 • Imaging | $158 | $414 | $656 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $44 | $416 | $775 |
| Chest X-ray single view CPT 71045 • Imaging | $8 | $20 | $25 |
| Chest X-ray 2 views CPT 71046 • Imaging | $8 | $28 | $42 |
| CT chest without contrast CPT 71250 • Imaging | $47 | $317 | $402 |
| CT chest with contrast CPT 71260 • Imaging | $43 | $230 | $470 |
| CT chest without then with contrast CPT 71270 • Imaging | $429 | $445 | $461 |
| CT angiography chest CPT 71275 • Imaging | $79 | $377 | $616 |
| CT cervical spine without contrast CPT 72125 • Imaging | $346 | $366 | $387 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $103 | $224 | $346 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $103 | $224 | $346 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $55 | $422 | $621 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $44 | $305 | $553 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $56 | $370 | $553 |
| CT pelvis without contrast CPT 72192 • Imaging | $188 | $188 | $188 |
| CT pelvis with contrast CPT 72193 • Imaging | $465 | $492 | $519 |
| X-ray shoulder complete CPT 73030 • Imaging | $21 | $45 | $59 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $51 | $232 | $553 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $23 | $49 | $63 |
| X-ray ankle complete CPT 73610 • Imaging | $8 | $53 | $72 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $50 | $510 | $724 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $60 | $352 | $621 |
| CT abdomen without contrast CPT 74150 • Imaging | $44 | $282 | $358 |
| CT abdomen with contrast CPT 74160 • Imaging | $344 | $344 | $344 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $144 | $292 | $440 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $76 | $271 | $415 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $80 | $452 | $717 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $74 | $575 | $814 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $30 | $204 | $280 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $32 | $191 | $264 |
| Ultrasound transvaginal CPT 76830 • Imaging | $71 | $169 | $253 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $31 | $129 | $228 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $31 | $164 | $273 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $38 | $208 | $346 |
| Screening mammography bilateral CPT 77067 • Imaging | $33 | $186 | $314 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $96 | $96 | $96 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $71 | $447 | $995 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $3 | $5 | $6 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $15 | $24 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $4 | $16 | $25 |
| Lipid panel CPT 80061 • Laboratory | $8 | $28 | $39 |
| Hepatic function panel CPT 80076 • Laboratory | $4 | $14 | $24 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $7 | $9 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $5 | $8 |