| CT maxillofacial without contrast CPT 70486 • Imaging | $34 | $106 | $154 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $54 | $70 | $86 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $66 | $131 | $223 |
| CT angiography neck CPT 70498 • Imaging | $83 | $182 | $300 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $84 | $229 | $415 |
| MRI brain without contrast CPT 70551 • Imaging | $71 | $160 | $239 |
| MRI brain with contrast CPT 70552 • Imaging | $70 | $200 | $330 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $267 | $316 | $389 |
| Chest X-ray single view CPT 71045 • Imaging | $7 | $17 | $27 |
| Chest X-ray 2 views CPT 71046 • Imaging | $11 | $18 | $25 |
| CT chest without contrast CPT 71250 • Imaging | $46 | $74 | $99 |
| CT chest with contrast CPT 71260 • Imaging | $49 | $94 | $170 |
| CT chest without then with contrast CPT 71270 • Imaging | $181 | $210 | $238 |
| CT angiography chest CPT 71275 • Imaging | $72 | $156 | $310 |
| CT cervical spine without contrast CPT 72125 • Imaging | $60 | $100 | $157 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $49 | $109 | $156 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $39 | $109 | $156 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $59 | $149 | $233 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $59 | $159 | $232 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $72 | $125 | $231 |
| CT pelvis without contrast CPT 72192 • Imaging | $43 | $47 | $52 |
| CT pelvis with contrast CPT 72193 • Imaging | $46 | $123 | $267 |
| X-ray shoulder complete CPT 73030 • Imaging | $26 | $32 | $36 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $54 | $169 | $245 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $9 | $21 | $36 |
| X-ray ankle complete CPT 73610 • Imaging | $23 | $28 | $38 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $64 | $189 | $300 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $66 | $127 | $245 |
| CT abdomen without contrast CPT 74150 • Imaging | $117 | $144 | $166 |
| CT abdomen with contrast CPT 74160 • Imaging | $143 | $143 | $143 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $55 | $134 | $281 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $84 | $150 | $209 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $87 | $241 | $373 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $97 | $292 | $417 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $39 | $88 | $127 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $26 | $87 | $118 |
| Ultrasound transvaginal CPT 76830 • Imaging | $96 | $124 | $149 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $27 | $83 | $115 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $105 | $125 | $137 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $93 | $141 | $174 |
| Screening mammography bilateral CPT 77067 • Imaging | $30 | $78 | $134 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $23 | $32 | $40 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $373 | $476 | $540 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $3 | $7 | $17 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $7 | $8 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $4 | $6 | $8 |
| Lipid panel CPT 80061 • Laboratory | $6 | $9 | $13 |
| Hepatic function panel CPT 80076 • Laboratory | $3 | $6 | $8 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $2 | $3 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $3 | $3 |