| CT head without then with contrast CPT 70470 • Imaging | $69 | $149 | $228 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $75 | $78 | $81 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $62 | $84 | $107 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $109 | $239 | $369 |
| CT angiography neck CPT 70498 • Imaging | $96 | $234 | $373 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $148 | $406 | $708 |
| MRI brain without contrast CPT 70551 • Imaging | $130 | $395 | $649 |
| MRI brain with contrast CPT 70552 • Imaging | $81 | $457 | $897 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $447 | $579 | $702 |
| Chest X-ray single view CPT 71045 • Imaging | $8 | $27 | $44 |
| Chest X-ray 2 views CPT 71046 • Imaging | $18 | $33 | $59 |
| CT chest without contrast CPT 71250 • Imaging | $110 | $141 | $157 |
| CT chest with contrast CPT 71260 • Imaging | $64 | $151 | $239 |
| CT chest without then with contrast CPT 71270 • Imaging | $116 | $204 | $292 |
| CT angiography chest CPT 71275 • Imaging | $99 | $309 | $450 |
| CT cervical spine without contrast CPT 72125 • Imaging | $54 | $121 | $189 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $76 | $132 | $189 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $54 | $168 | $282 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $141 | $374 | $631 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $57 | $246 | $396 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $143 | $344 | $634 |
| CT pelvis without contrast CPT 72192 • Imaging | $97 | $100 | $103 |
| CT pelvis with contrast CPT 72193 • Imaging | $53 | $191 | $330 |
| X-ray shoulder complete CPT 73030 • Imaging | $30 | $50 | $60 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $118 | $288 | $459 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $30 | $50 | $60 |
| X-ray ankle complete CPT 73610 • Imaging | $8 | $26 | $46 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $336 | $363 | $412 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $117 | $152 | $210 |
| CT abdomen without contrast CPT 74150 • Imaging | $65 | $140 | $243 |
| CT abdomen with contrast CPT 74160 • Imaging | $54 | $191 | $328 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $138 | $256 | $373 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $95 | $207 | $326 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $173 | $325 | $542 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $294 | $460 | $607 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $77 | $126 | $200 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $47 | $147 | $207 |
| Ultrasound transvaginal CPT 76830 • Imaging | $29 | $100 | $205 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $18 | $70 | $135 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $109 | $141 | $167 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $96 | $193 | $270 |
| Screening mammography bilateral CPT 77067 • Imaging | $111 | $148 | $177 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $19 | $21 | $24 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $66 | $436 | $863 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $4 | $7 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $9 | $16 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $2 | $4 | $5 |
| Lipid panel CPT 80061 • Laboratory | $6 | $6 | $7 |
| Hepatic function panel CPT 80076 • Laboratory | $1 | $4 | $6 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $4 | $6 |