| CT angiography neck CPT 70498 • Imaging | $30 | $190 | $479 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $30 | $367 | $855 |
| MRI brain without contrast CPT 70551 • Imaging | $40 | $167 | $318 |
| MRI brain with contrast CPT 70552 • Imaging | $261 | $317 | $374 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $30 | $367 | $547 |
| Chest X-ray single view CPT 71045 • Imaging | $7 | $13 | $23 |
| Chest X-ray 2 views CPT 71046 • Imaging | $21 | $32 | $43 |
| CT chest without contrast CPT 71250 • Imaging | $30 | $122 | $349 |
| CT chest with contrast CPT 71260 • Imaging | $41 | $100 | $168 |
| CT chest without then with contrast CPT 71270 • Imaging | $30 | $164 | $298 |
| CT angiography chest CPT 71275 • Imaging | $64 | $103 | $137 |
| CT cervical spine without contrast CPT 72125 • Imaging | $30 | $138 | $350 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $30 | $43 | $65 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $30 | $138 | $348 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $30 | $231 | $495 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $30 | $163 | $295 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $30 | $260 | $528 |
| CT pelvis without contrast CPT 72192 • Imaging | $51 | $125 | $198 |
| CT pelvis with contrast CPT 72193 • Imaging | $30 | $171 | $311 |
| X-ray shoulder complete CPT 73030 • Imaging | $27 | $29 | $31 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $184 | $357 | $556 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $10 | $28 | $56 |
| X-ray ankle complete CPT 73610 • Imaging | $30 | $31 | $33 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $184 | $358 | $532 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $48 | $240 | $568 |
| CT abdomen without contrast CPT 74150 • Imaging | $30 | $54 | $80 |
| CT abdomen with contrast CPT 74160 • Imaging | $280 | $280 | $280 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $30 | $84 | $145 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $77 | $112 | $143 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $65 | $261 | $392 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $85 | $231 | $351 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $41 | $87 | $114 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $30 | $79 | $124 |
| Ultrasound transvaginal CPT 76830 • Imaging | $25 | $69 | $115 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $56 | $112 | $167 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $91 | $105 | $113 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $115 | $177 | $238 |
| Screening mammography bilateral CPT 77067 • Imaging | $95 | $133 | $192 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $29 | $55 | $82 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $321 | $517 | $1,009 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $3 | $5 |
| Basic metabolic panel CPT 80048 • Laboratory | $7 | $10 | $13 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $3 | $4 | $6 |
| Lipid panel CPT 80061 • Laboratory | $3 | $8 | $11 |
| Hepatic function panel CPT 80076 • Laboratory | $4 | $5 | $7 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $2 | $3 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $3 | $4 | $6 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $2 | $33 | $96 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $25 | $27 | $28 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $8 | $18 | $24 |