| CT soft tissue neck with contrast CPT 70491 • Imaging | $120 | $147 | $173 |
| CT angiography neck CPT 70498 • Imaging | $152 | $202 | $252 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $42 | $42 | $42 |
| MRI brain without contrast CPT 70551 • Imaging | $165 | $302 | $371 |
| MRI brain with contrast CPT 70552 • Imaging | $121 | $256 | $370 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $42 | $196 | $327 |
| Chest X-ray single view CPT 71045 • Imaging | $7 | $14 | $21 |
| Chest X-ray 2 views CPT 71046 • Imaging | $23 | $25 | $28 |
| CT chest without contrast CPT 71250 • Imaging | $102 | $118 | $134 |
| CT chest with contrast CPT 71260 • Imaging | $47 | $73 | $108 |
| CT chest without then with contrast CPT 71270 • Imaging | $285 | $285 | $285 |
| CT angiography chest CPT 71275 • Imaging | $51 | $162 | $309 |
| CT cervical spine without contrast CPT 72125 • Imaging | $66 | $67 | $68 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $26 | $47 | $68 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $83 | $99 | $114 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $74 | $201 | $370 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $71 | $115 | $159 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $74 | $191 | $370 |
| CT pelvis without contrast CPT 72192 • Imaging | $30 | $30 | $30 |
| CT pelvis with contrast CPT 72193 • Imaging | $80 | $96 | $112 |
| X-ray shoulder complete CPT 73030 • Imaging | $22 | $28 | $31 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $42 | $124 | $207 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $18 | $29 | $44 |
| X-ray ankle complete CPT 73610 • Imaging | $25 | $38 | $46 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $46 | $46 | $46 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $179 | $219 | $259 |
| CT abdomen without contrast CPT 74150 • Imaging | $28 | $90 | $153 |
| CT abdomen with contrast CPT 74160 • Imaging | $88 | $131 | $174 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $118 | $118 | $118 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $154 | $188 | $206 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $87 | $190 | $321 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $95 | $230 | $364 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $52 | $94 | $135 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $50 | $67 | $88 |
| Ultrasound transvaginal CPT 76830 • Imaging | $19 | $93 | $164 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $26 | $43 | $61 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $72 | $74 | $76 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $43 | $88 | $132 |
| Screening mammography bilateral CPT 77067 • Imaging | $27 | $67 | $107 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $32 | $35 | $39 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $50 | $334 | $631 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $1 | $7 | $17 |
| Basic metabolic panel CPT 80048 • Laboratory | $1 | $2 | $4 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $4 | $4 | $4 |
| Lipid panel CPT 80061 • Laboratory | $2 | $13 | $24 |
| Hepatic function panel CPT 80076 • Laboratory | $1 | $1 | $1 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $3 | $6 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $1 | $3 | $6 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $1 | $3 | $6 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $3 | $15 | $27 |