| CT angiography neck CPT 70498 • Imaging | $62 | $302 | $542 |
| MRI orbits face neck with and without contrast CPT 70543 • Imaging | $622 | $667 | $712 |
| MRI brain without contrast CPT 70551 • Imaging | $30 | $314 | $504 |
| MRI brain with contrast CPT 70552 • Imaging | $170 | $433 | $696 |
| MRI brain without contrast then with contrast CPT 70553 • Imaging | $549 | $609 | $669 |
| Chest X-ray single view CPT 71045 • Imaging | $16 | $23 | $29 |
| Chest X-ray 2 views CPT 71046 • Imaging | $35 | $37 | $39 |
| CT chest without contrast CPT 71250 • Imaging | $30 | $129 | $290 |
| CT chest with contrast CPT 71260 • Imaging | $41 | $236 | $425 |
| CT chest without then with contrast CPT 71270 • Imaging | $30 | $81 | $131 |
| CT angiography chest CPT 71275 • Imaging | $64 | $363 | $644 |
| CT cervical spine without contrast CPT 72125 • Imaging | $35 | $65 | $95 |
| CT thoracic spine without contrast CPT 72128 • Imaging | $35 | $65 | $95 |
| CT lumbar spine without contrast CPT 72131 • Imaging | $35 | $112 | $189 |
| MRI cervical spine without contrast CPT 72141 • Imaging | $30 | $260 | $493 |
| MRI thoracic spine without contrast CPT 72146 • Imaging | $142 | $317 | $492 |
| MRI lumbar spine without contrast CPT 72148 • Imaging | $257 | $376 | $494 |
| CT pelvis without contrast CPT 72192 • Imaging | $62 | $113 | $164 |
| CT pelvis with contrast CPT 72193 • Imaging | $30 | $181 | $332 |
| X-ray shoulder complete CPT 73030 • Imaging | $21 | $37 | $60 |
| MRI joint upper extremity without contrast CPT 73221 • Imaging | $131 | $244 | $357 |
| X-ray knee 1-2 views CPT 73560 • Imaging | $16 | $21 | $26 |
| X-ray ankle complete CPT 73610 • Imaging | $22 | $39 | $63 |
| MRI lower extremity without contrast CPT 73718 • Imaging | $471 | $525 | $578 |
| MRI joint lower extremity without contrast CPT 73721 • Imaging | $48 | $305 | $525 |
| CT abdomen without contrast CPT 74150 • Imaging | $161 | $256 | $351 |
| CT abdomen with contrast CPT 74160 • Imaging | $122 | $122 | $122 |
| CT abdomen without then with contrast CPT 74170 • Imaging | $145 | $327 | $509 |
| CT abdomen and pelvis without contrast CPT 74176 • Imaging | $62 | $232 | $468 |
| CT abdomen and pelvis with contrast CPT 74177 • Imaging | $65 | $337 | $790 |
| CT abdomen and pelvis without then with contrast CPT 74178 • Imaging | $361 | $639 | $884 |
| Ultrasound abdominal complete CPT 76700 • Imaging | $156 | $156 | $156 |
| Ultrasound retroperitoneal complete CPT 76770 • Imaging | $74 | $77 | $80 |
| Ultrasound transvaginal CPT 76830 • Imaging | $88 | $163 | $237 |
| Ultrasound pelvic complete CPT 76856 • Imaging | $69 | $69 | $69 |
| Diagnostic mammography unilateral CPT 77065 • Imaging | $91 | $126 | $168 |
| Diagnostic mammography bilateral CPT 77066 • Imaging | $115 | $165 | $214 |
| Screening mammography bilateral CPT 77067 • Imaging | $95 | $156 | $251 |
| DEXA bone density study axial skeleton CPT 77080 • Imaging | $29 | $50 | $72 |
| Nuclear myocardial perfusion study CPT 78452 • Imaging | $151 | $522 | $1,095 |
| Collection of venous blood by venipuncture CPT 36415 • Laboratory | $5 | $10 | $14 |
| Basic metabolic panel CPT 80048 • Laboratory | $8 | $11 | $14 |
| Comprehensive metabolic panel CPT 80053 • Laboratory | $3 | $10 | $18 |
| Lipid panel CPT 80061 • Laboratory | $4 | $10 | $13 |
| Hepatic function panel CPT 80076 • Laboratory | $8 | $9 | $11 |
| Urinalysis with microscopy CPT 81001 • Laboratory | $1 | $3 | $5 |
| Urinalysis nonautomated without microscopy CPT 81002 • Laboratory | $2 | $3 | $6 |
| Urinalysis automated without microscopy CPT 81003 • Laboratory | $1 | $2 | $4 |
| Fecal hemoglobin immunoassay CPT 82274 • Laboratory | $15 | $19 | $26 |
| Vitamin D 25-hydroxy CPT 82306 • Laboratory | $8 | $26 | $39 |