| CT maxillofacial without contrast CPT 70486 • Imaging | $54 | $147 | $239 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $71 | $247 | $422 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $87 | $134 | $181 |
| CT angiography neck CPT 70498 • Imaging | $111 | $169 | $228 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $13 | $458 | $1,226 |
| MRI brain without contrast CPT 70551 • Imaging | $13 | $113 | $193 |
| MRI brain with contrast CPT 70552 • Imaging | $13 | $234 | $567 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $13 | $268 | $646 |
| Chest X-ray single view CPT 71045 • Imaging | $15 | $25 | $42 |
| Chest X-ray 2 views CPT 71046 • Imaging | $18 | $24 | $28 |
| CT chest without contrast CPT 71250 • Imaging | $44 | $199 | $452 |
| CT chest with contrast CPT 71260 • Imaging | $13 | $232 | $573 |
| CT chest without then with contrast CPT 71270 • Imaging | $87 | $297 | $507 |
| CT angiography chest CPT 71275 • Imaging | $13 | $214 | $513 |
| CT cervical spine without contrast CPT 72125 • Imaging | $68 | $104 | $140 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $131 | $152 | $173 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $114 | $216 | $318 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $13 | $279 | $640 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $61 | $260 | $562 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $13 | $132 | $194 |
| CT pelvis without contrast CPT 72192 • Imaging | $69 | $146 | $224 |
| CT pelvis with contrast CPT 72193 • Imaging | $80 | $246 | $413 |
| X-ray shoulder complete CPT 73030 • Imaging | $24 | $57 | $102 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $51 | $183 | $413 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $22 | $27 | $36 |
| X-ray ankle complete CPT 73610 • Imaging | $16 | $46 | $102 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $13 | $335 | $908 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $13 | $123 | $179 |
| CT abdomen without contrast CPT 74150 • Imaging | $13 | $81 | $156 |
| CT abdomen with contrast CPT 74160 • Imaging | $80 | $329 | $577 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $88 | $372 | $656 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $154 | $289 | $438 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $158 | $349 | $540 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $264 | $574 | $883 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $96 | $132 | $204 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $13 | $52 | $96 |
| Ultrasound transvaginal CPT 76830 • Imaging | $80 | $171 | $308 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $13 | $81 | $187 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $51 | $111 | $222 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $89 | $108 | $127 |
| Screening mammography bilateral CPT 77067 • Imaging | $68 | $215 | $342 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $27 | $34 | $41 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $108 | $157 | $205 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $4 | $7 |
| Basic metabolic panel CPT 80048 • Laboratory | $7 | $9 | $12 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $9 | $11 | $13 |
| Lipid panel CPT 80061 • Laboratory | $11 | $21 | $36 |
| Hepatic function panel CPT 80076 • Laboratory | $7 | $9 | $12 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $3 | $4 | $6 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $4 | $6 |