| CT soft tissue neck with contrast CPT 70491 • Imaging | $41 | $260 | $619 |
| CT angiography neck CPT 70498 • Imaging | $30 | $137 | $229 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $30 | $249 | $377 |
| MRI brain without contrast CPT 70551 • Imaging | $40 | $253 | $619 |
| MRI brain with contrast CPT 70552 • Imaging | $121 | $363 | $605 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $30 | $432 | $993 |
| Chest X-ray single view CPT 71045 • Imaging | $10 | $30 | $55 |
| Chest X-ray 2 views CPT 71046 • Imaging | $29 | $36 | $44 |
| CT chest without contrast CPT 71250 • Imaging | $30 | $97 | $133 |
| CT chest with contrast CPT 71260 • Imaging | $108 | $147 | $168 |
| CT chest without then with contrast CPT 71270 • Imaging | $30 | $105 | $180 |
| CT angiography chest CPT 71275 • Imaging | $139 | $195 | $252 |
| CT cervical spine without contrast CPT 72125 • Imaging | $30 | $204 | $493 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $30 | $111 | $173 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $30 | $92 | $131 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $30 | $161 | $233 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $30 | $259 | $614 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $71 | $221 | $419 |
| CT pelvis without contrast CPT 72192 • Imaging | $240 | $240 | $240 |
| CT pelvis with contrast CPT 72193 • Imaging | $41 | $238 | $593 |
| X-ray shoulder complete CPT 73030 • Imaging | $30 | $42 | $53 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $255 | $448 | $641 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $11 | $28 | $54 |
| X-ray ankle complete CPT 73610 • Imaging | $23 | $37 | $46 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $746 | $746 | $746 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $179 | $308 | $642 |
| CT abdomen without contrast CPT 74150 • Imaging | $30 | $178 | $392 |
| CT abdomen with contrast CPT 74160 • Imaging | $88 | $263 | $438 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $30 | $272 | $515 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $103 | $194 | $321 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $158 | $279 | $377 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $259 | $505 | $951 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $72 | $180 | $357 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $30 | $136 | $336 |
| Ultrasound transvaginal CPT 76830 • Imaging | $56 | $102 | $161 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $47 | $132 | $314 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $72 | $139 | $234 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $89 | $258 | $427 |
| Screening mammography bilateral CPT 77067 • Imaging | $68 | $142 | $247 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $39 | $104 | $170 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $140 | $715 | $1,394 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $8 | $17 |
| Basic metabolic panel CPT 80048 • Laboratory | $7 | $9 | $11 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $12 | $12 | $12 |
| Lipid panel CPT 80061 • Laboratory | $11 | $18 | $24 |
| Hepatic function panel CPT 80076 • Laboratory | $7 | $9 | $11 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $3 | $4 | $6 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $1 | $4 | $7 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $2 | $4 | $6 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $12 | $20 | $27 |