| CT head without then with contrast CPT 70470 • Imaging | $38 | $49 | $60 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $95 | $142 | $235 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $33 | $158 | $282 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $203 | $207 | $211 |
| CT angiography neck CPT 70498 • Imaging | $62 | $246 | $538 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $101 | $211 | $267 |
| MRI brain without contrast CPT 70551 • Imaging | $216 | $334 | $453 |
| MRI brain with contrast CPT 70552 • Imaging | $90 | $256 | $421 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $111 | $113 | $115 |
| Chest X-ray single view CPT 71045 • Imaging | $16 | $19 | $25 |
| Chest X-ray 2 views CPT 71046 • Imaging | $14 | $24 | $32 |
| CT chest without contrast CPT 71250 • Imaging | $29 | $65 | $146 |
| CT chest with contrast CPT 71260 • Imaging | $41 | $139 | $274 |
| CT chest without then with contrast CPT 71270 • Imaging | $62 | $166 | $270 |
| CT angiography chest CPT 71275 • Imaging | $64 | $193 | $327 |
| CT cervical spine without contrast CPT 72125 • Imaging | $35 | $117 | $224 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $35 | $100 | $173 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $35 | $109 | $220 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $135 | $270 | $406 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $42 | $220 | $409 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $211 | $272 | $333 |
| CT pelvis without contrast CPT 72192 • Imaging | $29 | $81 | $162 |
| CT pelvis with contrast CPT 72193 • Imaging | $204 | $225 | $245 |
| X-ray shoulder complete CPT 73030 • Imaging | $7 | $17 | $23 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $68 | $187 | $425 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $9 | $17 | $26 |
| X-ray ankle complete CPT 73610 • Imaging | $6 | $16 | $27 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $123 | $249 | $376 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $48 | $176 | $434 |
| CT abdomen without contrast CPT 74150 • Imaging | $30 | $124 | $218 |
| CT abdomen with contrast CPT 74160 • Imaging | $126 | $211 | $296 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $129 | $200 | $325 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $62 | $114 | $201 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $65 | $223 | $335 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $101 | $269 | $375 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $38 | $75 | $111 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $21 | $45 | $80 |
| Ultrasound transvaginal CPT 76830 • Imaging | $88 | $97 | $115 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $31 | $84 | $120 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $36 | $71 | $120 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $44 | $115 | $152 |
| Screening mammography bilateral CPT 77067 • Imaging | $95 | $116 | $123 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $9 | $16 | $29 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $321 | $405 | $470 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $4 | $7 |
| Basic metabolic panel CPT 80048 • Laboratory | $6 | $6 | $7 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $2 | $5 | $8 |
| Lipid panel CPT 80061 • Laboratory | $4 | $8 | $11 |
| Hepatic function panel CPT 80076 • Laboratory | $6 | $6 | $7 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $2 | $3 |