| CT maxillofacial without contrast CPT 70486 • Imaging | $41 | $46 | $52 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $54 | $162 | $270 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $187 | $227 | $266 |
| CT angiography neck CPT 70498 • Imaging | $80 | $82 | $84 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $103 | $375 | $647 |
| MRI brain without contrast CPT 70551 • Imaging | $199 | $322 | $444 |
| MRI brain with contrast CPT 70552 • Imaging | $81 | $81 | $81 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $110 | $376 | $642 |
| Chest X-ray single view CPT 71045 • Imaging | $9 | $13 | $18 |
| Chest X-ray 2 views CPT 71046 • Imaging | $21 | $24 | $28 |
| CT chest without contrast CPT 71250 • Imaging | $52 | $52 | $53 |
| CT chest with contrast CPT 71260 • Imaging | $57 | $60 | $63 |
| CT chest without then with contrast CPT 71270 • Imaging | $268 | $268 | $268 |
| CT angiography chest CPT 71275 • Imaging | $87 | $87 | $87 |
| CT cervical spine without contrast CPT 72125 • Imaging | $49 | $51 | $53 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $49 | $110 | $171 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $49 | $51 | $53 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $71 | $238 | $405 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $71 | $242 | $413 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $191 | $299 | $407 |
| CT pelvis without contrast CPT 72192 • Imaging | $52 | $107 | $162 |
| CT pelvis with contrast CPT 72193 • Imaging | $56 | $155 | $255 |
| X-ray shoulder complete CPT 73030 • Imaging | $9 | $15 | $21 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $62 | $63 | $65 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $25 | $25 | $25 |
| X-ray ankle complete CPT 73610 • Imaging | $8 | $8 | $8 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $61 | $63 | $65 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $208 | $287 | $365 |
| CT abdomen without contrast CPT 74150 • Imaging | $57 | $136 | $215 |
| CT abdomen with contrast CPT 74160 • Imaging | $58 | $58 | $58 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $263 | $320 | $377 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $84 | $104 | $124 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $226 | $274 | $321 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $97 | $251 | $406 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $81 | $99 | $116 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $26 | $30 | $34 |
| Ultrasound transvaginal CPT 76830 • Imaging | $73 | $96 | $119 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $31 | $69 | $107 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $36 | $81 | $126 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $49 | $78 | $108 |
| Screening mammography bilateral CPT 77067 • Imaging | $123 | $125 | $126 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $40 | $62 | $84 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $78 | $235 | $391 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $3 | $5 |
| Basic metabolic panel CPT 80048 • Laboratory | $6 | $6 | $6 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $3 | $6 | $8 |
| Lipid panel CPT 80061 • Laboratory | $7 | $9 | $11 |
| Hepatic function panel CPT 80076 • Laboratory | $6 | $6 | $6 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $2 | $3 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $1 | $2 | $3 |