| CT head without then with contrast CPT 70470 • Imaging | $40 | $72 | $104 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $171 | $308 | $445 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $34 | $232 | $430 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $113 | $142 | $171 |
| CT angiography neck CPT 70498 • Imaging | $120 | $490 | $861 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $174 | $204 | $250 |
| MRI brain without contrast CPT 70551 • Imaging | $120 | $186 | $250 |
| MRI brain with contrast CPT 70552 • Imaging | $125 | $454 | $1,049 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $40 | $116 | $192 |
| Chest X-ray single view CPT 71045 • Imaging | $6 | $13 | $17 |
| Chest X-ray 2 views CPT 71046 • Imaging | $7 | $25 | $54 |
| CT chest without contrast CPT 71250 • Imaging | $86 | $215 | $475 |
| CT chest with contrast CPT 71260 • Imaging | $40 | $64 | $101 |
| CT chest without then with contrast CPT 71270 • Imaging | $120 | $353 | $586 |
| CT angiography chest CPT 71275 • Imaging | $86 | $412 | $738 |
| CT cervical spine without contrast CPT 72125 • Imaging | $171 | $276 | $382 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $51 | $216 | $381 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $86 | $280 | $474 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $63 | $372 | $866 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $63 | $420 | $777 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $50 | $338 | $776 |
| CT pelvis without contrast CPT 72192 • Imaging | $120 | $289 | $458 |
| CT pelvis with contrast CPT 72193 • Imaging | $86 | $313 | $540 |
| X-ray shoulder complete CPT 73030 • Imaging | $11 | $13 | $15 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $62 | $78 | $110 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $22 | $34 | $47 |
| X-ray ankle complete CPT 73610 • Imaging | $12 | $14 | $17 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $125 | $366 | $786 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $50 | $394 | $883 |
| CT abdomen without contrast CPT 74150 • Imaging | $34 | $66 | $97 |
| CT abdomen with contrast CPT 74160 • Imaging | $40 | $314 | $588 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $114 | $143 | $171 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $120 | $150 | $171 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $51 | $282 | $623 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $51 | $275 | $601 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $39 | $127 | $215 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $40 | $124 | $207 |
| Ultrasound transvaginal CPT 76830 • Imaging | $22 | $39 | $56 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $40 | $48 | $56 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $27 | $107 | $234 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $109 | $142 | $208 |
| Screening mammography bilateral CPT 77067 • Imaging | $63 | $130 | $240 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $6 | $70 | $135 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $250 | $508 | $858 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $1 | $3 | $5 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $13 | $20 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $9 | $15 | $21 |
| Lipid panel CPT 80061 • Laboratory | $11 | $22 | $33 |
| Hepatic function panel CPT 80076 • Laboratory | $4 | $12 | $20 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $5 | $8 |