| CT maxillofacial without contrast CPT 70486 • Imaging | $131 | $143 | $156 |
| CT maxillofacial with contrast CPT 70487 • Imaging | $54 | $89 | $123 |
| CT soft tissue neck with contrast CPT 70491 • Imaging | $66 | $146 | $226 |
| CT angiography neck CPT 70498 • Imaging | $84 | $91 | $98 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $103 | $209 | $315 |
| MRI brain without contrast CPT 70551 • Imaging | $84 | $142 | $199 |
| MRI brain with contrast CPT 70552 • Imaging | $100 | $100 | $100 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $110 | $194 | $279 |
| Chest X-ray single view CPT 71045 • Imaging | $9 | $19 | $25 |
| Chest X-ray 2 views CPT 71046 • Imaging | $11 | $19 | $24 |
| CT chest without contrast CPT 71250 • Imaging | $52 | $82 | $112 |
| CT chest with contrast CPT 71260 • Imaging | $63 | $106 | $149 |
| CT chest without then with contrast CPT 71270 • Imaging | $77 | $77 | $77 |
| CT angiography chest CPT 71275 • Imaging | $87 | $162 | $236 |
| CT cervical spine without contrast CPT 72125 • Imaging | $49 | $52 | $56 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $49 | $83 | $118 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $49 | $111 | $173 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $159 | $177 | $195 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $71 | $77 | $84 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $84 | $138 | $191 |
| CT pelvis without contrast CPT 72192 • Imaging | $52 | $57 | $61 |
| CT pelvis with contrast CPT 72193 • Imaging | $55 | $163 | $270 |
| X-ray shoulder complete CPT 73030 • Imaging | $21 | $30 | $33 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $65 | $161 | $257 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $8 | $16 | $24 |
| X-ray ankle complete CPT 73610 • Imaging | $25 | $30 | $35 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $65 | $139 | $212 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $208 | $232 | $256 |
| CT abdomen without contrast CPT 74150 • Imaging | $57 | $62 | $67 |
| CT abdomen with contrast CPT 74160 • Imaging | $72 | $72 | $72 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $79 | $171 | $263 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $84 | $91 | $98 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $263 | $284 | $305 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $97 | $105 | $113 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $46 | $65 | $84 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $78 | $103 | $127 |
| Ultrasound transvaginal CPT 76830 • Imaging | $33 | $55 | $99 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $33 | $60 | $107 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $39 | $95 | $150 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $133 | $146 | $160 |
| Screening mammography bilateral CPT 77067 • Imaging | $37 | $40 | $43 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $11 | $26 | $40 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $89 | $197 | $305 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $3 | $4 | $5 |
| Basic metabolic panel CPT 80048 • Laboratory | $4 | $6 | $7 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $4 | $7 | $9 |
| Lipid panel CPT 80061 • Laboratory | $3 | $8 | $12 |
| Hepatic function panel CPT 80076 • Laboratory | $3 | $5 | $7 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $2 | $3 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $1 | $2 | $2 |