| CT head without then with contrast CPT 70470 • Imaging | $58 | $105 | $152 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $115 | $209 | $346 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $71 | $89 | $107 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $87 | $292 | $542 |
| CT angiography neck CPT 70498 • Imaging | $111 | $289 | $492 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $123 | $310 | $699 |
| MRI brain without contrast CPT 70551 • Imaging | $94 | $270 | $621 |
| MRI brain with contrast CPT 70552 • Imaging | $113 | $252 | $348 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $119 | $258 | $635 |
| Chest X-ray single view CPT 71045 • Imaging | $8 | $16 | $24 |
| Chest X-ray 2 views CPT 71046 • Imaging | $10 | $22 | $43 |
| CT chest without contrast CPT 71250 • Imaging | $63 | $247 | $402 |
| CT chest with contrast CPT 71260 • Imaging | $67 | $114 | $195 |
| CT chest without then with contrast CPT 71270 • Imaging | $71 | $207 | $461 |
| CT angiography chest CPT 71275 • Imaging | $104 | $165 | $276 |
| CT cervical spine without contrast CPT 72125 • Imaging | $68 | $194 | $346 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $63 | $170 | $346 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $46 | $175 | $346 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $77 | $219 | $621 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $94 | $294 | $534 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $175 | $295 | $534 |
| CT pelvis without contrast CPT 72192 • Imaging | $69 | $89 | $109 |
| CT pelvis with contrast CPT 72193 • Imaging | $67 | $220 | $519 |
| X-ray shoulder complete CPT 73030 • Imaging | $15 | $35 | $55 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $79 | $111 | $169 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $14 | $35 | $55 |
| X-ray ankle complete CPT 73610 • Imaging | $10 | $36 | $72 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $77 | $277 | $669 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $184 | $298 | $621 |
| CT abdomen without contrast CPT 74150 • Imaging | $75 | $165 | $346 |
| CT abdomen with contrast CPT 74160 • Imaging | $80 | $153 | $226 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $81 | $203 | $440 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $123 | $131 | $136 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $272 | $407 | $717 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $311 | $461 | $814 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $46 | $54 | $65 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $42 | $106 | $192 |
| Ultrasound transvaginal CPT 76830 • Imaging | $44 | $89 | $138 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $40 | $42 | $44 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $47 | $132 | $224 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $52 | $118 | $161 |
| Screening mammography bilateral CPT 77067 • Imaging | $36 | $104 | $229 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $36 | $44 | $51 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $83 | $489 | $815 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $4 | $5 | $6 |
| Basic metabolic panel CPT 80048 • Laboratory | $5 | $11 | $19 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $6 | $16 | $28 |
| Lipid panel CPT 80061 • Laboratory | $6 | $18 | $32 |
| Hepatic function panel CPT 80076 • Laboratory | $3 | $11 | $19 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $4 | $8 |