| CT angiography neck CPT 70498 • Imaging | $84 | $153 | $223 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $103 | $246 | $391 |
| MRI brain without contrast CPT 70551 • Imaging | $71 | $125 | $158 |
| MRI brain with contrast CPT 70552 • Imaging | $97 | $164 | $232 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $110 | $199 | $244 |
| Chest X-ray single view CPT 71045 • Imaging | $9 | $19 | $29 |
| Chest X-ray 2 views CPT 71046 • Imaging | $11 | $25 | $38 |
| CT chest without contrast CPT 71250 • Imaging | $52 | $61 | $71 |
| CT chest with contrast CPT 71260 • Imaging | $56 | $124 | $193 |
| CT chest without then with contrast CPT 71270 • Imaging | $68 | $68 | $68 |
| CT angiography chest CPT 71275 • Imaging | $87 | $145 | $226 |
| CT cervical spine without contrast CPT 72125 • Imaging | $49 | $72 | $96 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $49 | $99 | $150 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $95 | $114 | $133 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $150 | $189 | $221 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $71 | $121 | $151 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $151 | $188 | $222 |
| CT pelvis without contrast CPT 72192 • Imaging | $52 | $103 | $154 |
| CT pelvis with contrast CPT 72193 • Imaging | $55 | $128 | $200 |
| X-ray shoulder complete CPT 73030 • Imaging | $21 | $25 | $29 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $65 | $101 | $164 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $25 | $27 | $29 |
| X-ray ankle complete CPT 73610 • Imaging | $9 | $20 | $31 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $64 | $125 | $185 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $74 | $149 | $208 |
| CT abdomen without contrast CPT 74150 • Imaging | $57 | $107 | $158 |
| CT abdomen with contrast CPT 74160 • Imaging | $199 | $199 | $199 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $226 | $244 | $263 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $118 | $143 | $184 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $99 | $189 | $243 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $97 | $150 | $243 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $39 | $85 | $131 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $71 | $91 | $122 |
| Ultrasound transvaginal CPT 76830 • Imaging | $38 | $79 | $119 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $33 | $47 | $71 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $39 | $42 | $44 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $54 | $105 | $156 |
| Screening mammography bilateral CPT 77067 • Imaging | $37 | $70 | $102 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $40 | $42 | $44 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $78 | $238 | $397 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $3 | $9 | $14 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $4 | $4 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $3 | $4 | $4 |
| Lipid panel CPT 80061 • Laboratory | $6 | $6 | $6 |
| Hepatic function panel CPT 80076 • Laboratory | $3 | $3 | $3 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $2 | $2 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $2 | $2 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $1 | $49 | $96 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $10 | $13 | $14 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $12 | $13 | $13 |