| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $30 | $131 | $231 |
| MRI brain without contrast CPT 70551 • Imaging | $40 | $190 | $370 |
| MRI brain with contrast CPT 70552 • Imaging | $75 | $189 | $370 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $30 | $151 | $327 |
| Chest X-ray single view CPT 71045 • Imaging | $7 | $15 | $23 |
| Chest X-ray 2 views CPT 71046 • Imaging | $8 | $22 | $29 |
| CT chest without contrast CPT 71250 • Imaging | $30 | $89 | $134 |
| CT chest with contrast CPT 71260 • Imaging | $85 | $140 | $237 |
| CT chest without then with contrast CPT 71270 • Imaging | $30 | $75 | $120 |
| CT angiography chest CPT 71275 • Imaging | $161 | $237 | $309 |
| CT cervical spine without contrast CPT 72125 • Imaging | $30 | $70 | $111 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $30 | $105 | $173 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $30 | $85 | $114 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $30 | $132 | $195 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $30 | $164 | $259 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $30 | $177 | $370 |
| CT pelvis without contrast CPT 72192 • Imaging | $41 | $41 | $41 |
| CT pelvis with contrast CPT 72193 • Imaging | $30 | $51 | $80 |
| X-ray shoulder complete CPT 73030 • Imaging | $7 | $31 | $66 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $42 | $50 | $58 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $7 | $26 | $43 |
| X-ray ankle complete CPT 73610 • Imaging | $25 | $36 | $46 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $64 | $110 | $156 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $58 | $203 | $371 |
| CT abdomen without contrast CPT 74150 • Imaging | $30 | $85 | $153 |
| CT abdomen with contrast CPT 74160 • Imaging | $48 | $68 | $88 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $30 | $126 | $221 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $154 | $171 | $205 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $69 | $216 | $321 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $76 | $264 | $364 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $27 | $65 | $95 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $30 | $56 | $88 |
| Ultrasound transvaginal CPT 76830 • Imaging | $66 | $108 | $164 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $42 | $90 | $146 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $69 | $89 | $110 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $35 | $85 | $132 |
| Screening mammography bilateral CPT 77067 • Imaging | $26 | $80 | $112 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $8 | $11 | $14 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $80 | $220 | $391 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $7 | $17 |
| Basic metabolic panel CPT 80048 • Laboratory | $5 | $6 | $7 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $6 | $7 | $8 |
| Lipid panel CPT 80061 • Laboratory | $8 | $14 | $24 |
| Hepatic function panel CPT 80076 • Laboratory | $5 | $6 | $7 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $3 | $6 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $4 | $7 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $1 | $2 | $4 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $8 | $15 | $27 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $18 | $21 | $24 |
| Creatine kinase (CK) total CPT 82550 • Laboratory | $4 | $5 | $5 |