| CT head without then with contrast CPT 70470 • Imaging | $71 | $79 | $86 |
| CT maxillofacial without contrast CPT 70486 • Imaging | $76 | $148 | $219 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $78 | $204 | $330 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $77 | $147 | $243 |
| CT angiography neck CPT 70498 • Imaging | $152 | $368 | $585 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $633 | $633 | $633 |
| MRI brain without contrast CPT 70551 • Imaging | $82 | $149 | $252 |
| MRI brain with contrast CPT 70552 • Imaging | $78 | $146 | $238 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $327 | $556 | $785 |
| Chest X-ray single view CPT 71045 • Imaging | $9 | $13 | $19 |
| Chest X-ray 2 views CPT 71046 • Imaging | $12 | $20 | $34 |
| CT chest without contrast CPT 71250 • Imaging | $65 | $126 | $169 |
| CT chest with contrast CPT 71260 • Imaging | $108 | $184 | $237 |
| CT chest without then with contrast CPT 71270 • Imaging | $70 | $73 | $77 |
| CT angiography chest CPT 71275 • Imaging | $107 | $160 | $213 |
| CT cervical spine without contrast CPT 72125 • Imaging | $65 | $77 | $89 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $168 | $170 | $173 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $65 | $90 | $114 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $49 | $198 | $406 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $111 | $228 | $415 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $155 | $271 | $498 |
| CT pelvis without contrast CPT 72192 • Imaging | $159 | $159 | $159 |
| CT pelvis with contrast CPT 72193 • Imaging | $65 | $143 | $284 |
| X-ray shoulder complete CPT 73030 • Imaging | $21 | $36 | $44 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $259 | $348 | $437 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $29 | $37 | $44 |
| X-ray ankle complete CPT 73610 • Imaging | $17 | $28 | $47 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $82 | $254 | $426 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $179 | $264 | $358 |
| CT abdomen without contrast CPT 74150 • Imaging | $72 | $115 | $158 |
| CT abdomen with contrast CPT 74160 • Imaging | $88 | $220 | $351 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $84 | $195 | $307 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $128 | $143 | $151 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $161 | $248 | $321 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $91 | $297 | $436 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $41 | $103 | $135 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $65 | $92 | $124 |
| Ultrasound transvaginal CPT 76830 • Imaging | $84 | $128 | $164 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $61 | $76 | $86 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $45 | $82 | $107 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $89 | $116 | $138 |
| Screening mammography bilateral CPT 77067 • Imaging | $43 | $74 | $107 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $12 | $47 | $82 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $91 | $322 | $492 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $2 | $7 | $17 |
| Basic metabolic panel CPT 80048 • Laboratory | $6 | $7 | $8 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $6 | $8 | $10 |
| Lipid panel CPT 80061 • Laboratory | $10 | $19 | $32 |
| Hepatic function panel CPT 80076 • Laboratory | $6 | $6 | $6 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $3 | $4 | $6 |