| MRI brain without contrast then with contrast CPT 70553 • Imaging | $80 | $183 | $358 |
| Chest X-ray single view CPT 71045 • Imaging | $9 | $13 | $20 |
| Chest X-ray 2 views CPT 71046 • Imaging | $8 | $18 | $29 |
| CT chest without contrast CPT 71250 • Imaging | $38 | $100 | $171 |
| CT chest with contrast CPT 71260 • Imaging | $56 | $169 | $296 |
| CT chest without then with contrast CPT 71270 • Imaging | $192 | $212 | $231 |
| CT angiography chest CPT 71275 • Imaging | $64 | $80 | $90 |
| CT cervical spine without contrast CPT 72125 • Imaging | $35 | $86 | $175 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $35 | $72 | $131 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $35 | $101 | $218 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $39 | $103 | $195 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $139 | $205 | $283 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $74 | $121 | $191 |
| CT pelvis without contrast CPT 72192 • Imaging | $43 | $78 | $139 |
| CT pelvis with contrast CPT 72193 • Imaging | $56 | $171 | $244 |
| X-ray shoulder complete CPT 73030 • Imaging | $9 | $16 | $23 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $65 | $79 | $103 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $15 | $21 | $26 |
| X-ray ankle complete CPT 73610 • Imaging | $6 | $18 | $26 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $64 | $82 | $115 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $34 | $155 | $224 |
| CT abdomen without contrast CPT 74150 • Imaging | $28 | $75 | $139 |
| CT abdomen with contrast CPT 74160 • Imaging | $61 | $108 | $155 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $70 | $95 | $145 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $62 | $90 | $105 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $205 | $282 | $335 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $97 | $162 | $290 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $40 | $87 | $116 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $36 | $43 | $55 |
| Ultrasound transvaginal CPT 76830 • Imaging | $82 | $102 | $119 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $19 | $77 | $107 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $39 | $55 | $88 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $43 | $105 | $160 |
| Screening mammography bilateral CPT 77067 • Imaging | $37 | $89 | $130 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $10 | $26 | $39 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $78 | $78 | $78 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $0 | $2 | $4 |
| Basic metabolic panel CPT 80048 • Laboratory | $5 | $7 | $8 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $2 | $4 | $6 |
| Lipid panel CPT 80061 • Laboratory | $6 | $9 | $11 |
| Hepatic function panel CPT 80076 • Laboratory | $5 | $6 | $6 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $2 | $3 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $1 | $2 | $2 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $0 | $1 | $2 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $6 | $11 | $15 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $8 | $17 | $24 |
| Creatine kinase (CK) total CPT 82550 • Laboratory | $3 | $4 | $4 |
| Creatinine urine CPT 82570 • Laboratory | $1 | $2 | $4 |
| Ferritin CPT 82728 • Laboratory | $6 | $7 | $9 |
| IgA IgD IgG IgM each CPT 82784 • Laboratory | $4 | $5 | $6 |