| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $30 | $323 | $616 |
| MRI brain without contrast CPT 70551 • Imaging | $70 | $239 | $323 |
| MRI brain with contrast CPT 70552 • Imaging | $421 | $436 | $451 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $30 | $188 | $504 |
| Chest X-ray single view CPT 71045 • Imaging | $9 | $16 | $23 |
| Chest X-ray 2 views CPT 71046 • Imaging | $28 | $28 | $29 |
| CT chest without contrast CPT 71250 • Imaging | $30 | $113 | $172 |
| CT chest with contrast CPT 71260 • Imaging | $274 | $274 | $274 |
| CT chest without then with contrast CPT 71270 • Imaging | $30 | $48 | $65 |
| CT angiography chest CPT 71275 • Imaging | $91 | $163 | $236 |
| CT cervical spine without contrast CPT 72125 • Imaging | $30 | $127 | $224 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $30 | $39 | $48 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $30 | $101 | $173 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $30 | $140 | $313 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $30 | $186 | $333 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $30 | $137 | $311 |
| CT pelvis without contrast CPT 72192 • Imaging | $162 | $162 | $162 |
| CT pelvis with contrast CPT 72193 • Imaging | $55 | $117 | $179 |
| X-ray shoulder complete CPT 73030 • Imaging | $20 | $27 | $32 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $65 | $153 | $241 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $9 | $24 | $32 |
| X-ray ankle complete CPT 73610 • Imaging | $24 | $29 | $33 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $376 | $376 | $376 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $332 | $383 | $434 |
| CT abdomen without contrast CPT 74150 • Imaging | $30 | $102 | $161 |
| CT abdomen with contrast CPT 74160 • Imaging | $296 | $296 | $296 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $30 | $48 | $66 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $81 | $118 | $155 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $246 | $248 | $251 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $278 | $296 | $332 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $97 | $116 | $135 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $30 | $82 | $128 |
| Ultrasound transvaginal CPT 76830 • Imaging | $88 | $93 | $97 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $30 | $31 | $32 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $29 | $87 | $120 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $136 | $144 | $152 |
| Screening mammography bilateral CPT 77067 • Imaging | $88 | $104 | $112 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $10 | $10 | $10 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $75 | $263 | $391 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $2 | $2 |
| Basic metabolic panel CPT 80048 • Laboratory | $6 | $7 | $8 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $6 | $6 | $6 |
| Lipid panel CPT 80061 • Laboratory | $9 | $10 | $11 |
| Hepatic function panel CPT 80076 • Laboratory | $6 | $6 | $7 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $3 | $3 | $3 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $2 | $3 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $2 | $2 | $2 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $14 | $15 | $16 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $21 | $26 | $28 |
| Creatine kinase (CK) total CPT 82550 • Laboratory | $5 | $5 | $5 |