| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $250 | $728 | $1,508 |
| MRI brain without contrast CPT 70551 • Imaging | $50 | $375 | $726 |
| MRI brain with contrast CPT 70552 • Imaging | $40 | $465 | $872 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $63 | $598 | $1,540 |
| Chest X-ray single view CPT 71045 • Imaging | $16 | $31 | $44 |
| Chest X-ray 2 views CPT 71046 • Imaging | $17 | $32 | $48 |
| CT chest without contrast CPT 71250 • Imaging | $30 | $158 | $413 |
| CT chest with contrast CPT 71260 • Imaging | $275 | $344 | $482 |
| CT chest without then with contrast CPT 71270 • Imaging | $60 | $325 | $589 |
| CT angiography chest CPT 71275 • Imaging | $120 | $402 | $635 |
| CT cervical spine without contrast CPT 72125 • Imaging | $34 | $224 | $413 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $86 | $249 | $413 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $51 | $232 | $413 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $50 | $375 | $735 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $216 | $423 | $802 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $188 | $440 | $793 |
| CT pelvis without contrast CPT 72192 • Imaging | $192 | $300 | $407 |
| CT pelvis with contrast CPT 72193 • Imaging | $275 | $369 | $464 |
| X-ray shoulder complete CPT 73030 • Imaging | $6 | $37 | $59 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $114 | $358 | $709 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $40 | $47 | $58 |
| X-ray ankle complete CPT 73610 • Imaging | $5 | $32 | $48 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $125 | $411 | $709 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $40 | $287 | $709 |
| CT abdomen without contrast CPT 74150 • Imaging | $139 | $261 | $402 |
| CT abdomen with contrast CPT 74160 • Imaging | $30 | $251 | $472 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $169 | $370 | $571 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $186 | $289 | $356 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $275 | $459 | $559 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $95 | $470 | $707 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $16 | $129 | $200 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $14 | $122 | $187 |
| Ultrasound transvaginal CPT 76830 • Imaging | $16 | $120 | $205 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $58 | $88 | $137 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $27 | $128 | $210 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $34 | $190 | $270 |
| Screening mammography bilateral CPT 77067 • Imaging | $63 | $114 | $215 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $24 | $92 | $161 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $132 | $487 | $1,029 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $3 | $4 |
| Basic metabolic panel CPT 80048 • Laboratory | $3 | $6 | $8 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $3 | $6 | $11 |
| Lipid panel CPT 80061 • Laboratory | $6 | $9 | $13 |
| Hepatic function panel CPT 80076 • Laboratory | $3 | $6 | $8 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $3 | $3 | $3 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $1 | $2 | $3 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $0 | $1 | $2 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $3 | $16 | $28 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $28 | $29 | $30 |
| Creatine kinase (CK) total CPT 82550 • Laboratory | $1 | $4 | $7 |