| CT soft tissue neck with contrast CPT 70491 • Imaging | $38 | $79 | $120 |
| CT angiography neck CPT 70498 • Imaging | $83 | $117 | $152 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $102 | $102 | $102 |
| MRI brain without contrast CPT 70551 • Imaging | $71 | $134 | $200 |
| MRI brain with contrast CPT 70552 • Imaging | $30 | $79 | $121 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $217 | $290 | $327 |
| Chest X-ray single view CPT 71045 • Imaging | $15 | $28 | $54 |
| Chest X-ray 2 views CPT 71046 • Imaging | $19 | $22 | $28 |
| CT chest without contrast CPT 71250 • Imaging | $83 | $107 | $134 |
| CT chest with contrast CPT 71260 • Imaging | $30 | $36 | $41 |
| CT chest without then with contrast CPT 71270 • Imaging | $100 | $100 | $100 |
| CT angiography chest CPT 71275 • Imaging | $139 | $216 | $256 |
| CT cervical spine without contrast CPT 72125 • Imaging | $35 | $51 | $66 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $35 | $41 | $48 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $48 | $81 | $114 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $125 | $168 | $195 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $159 | $183 | $195 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $30 | $82 | $187 |
| CT pelvis without contrast CPT 72192 • Imaging | $51 | $67 | $83 |
| CT pelvis with contrast CPT 72193 • Imaging | $80 | $125 | $169 |
| X-ray shoulder complete CPT 73030 • Imaging | $30 | $30 | $31 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $41 | $41 | $41 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $6 | $26 | $43 |
| X-ray ankle complete CPT 73610 • Imaging | $6 | $15 | $32 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $30 | $47 | $64 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $30 | $138 | $206 |
| CT abdomen without contrast CPT 74150 • Imaging | $139 | $139 | $139 |
| CT abdomen with contrast CPT 74160 • Imaging | $88 | $129 | $169 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $47 | $96 | $145 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $103 | $147 | $185 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $161 | $263 | $313 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $350 | $350 | $351 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $30 | $89 | $135 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $96 | $97 | $100 |
| Ultrasound transvaginal CPT 76830 • Imaging | $30 | $100 | $164 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $61 | $72 | $93 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $76 | $92 | $110 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $43 | $90 | $139 |
| Screening mammography bilateral CPT 77067 • Imaging | $32 | $80 | $112 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $29 | $30 | $32 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $68 | $153 | $321 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $0 | $9 | $17 |
| Basic metabolic panel CPT 80048 • Laboratory | $1 | $4 | $6 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $3 | $5 | $8 |
| Lipid panel CPT 80061 • Laboratory | $3 | $6 | $10 |
| Hepatic function panel CPT 80076 • Laboratory | $7 | $7 | $7 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $2 | $2 | $3 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $2 | $3 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $0 | $3 | $6 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $6 | $17 | $28 |