| Basic metabolic panel | $15 | $8 | 175% | — | 14 |
| CT abdomen and pelvis with contrast | $828 | $372 | 223% | — | 6 |
| CT head without contrast | $245 | $112 | 220% | — | 6 |
| CT pelvis with contrast | $402 | $187 | 215% | — | 6 |
| Cardiac stress test | $248 | $230 | 108% | — | 2 |
| Cataract surgery with IOL insertion | $2,452 | $2,462 | 100% | — | 15 |
| Colonoscopy with biopsy | $1,495 | $1,276 | 117% | — | 15 |
| Colonoscopy with endoscopic ultrasound | $1,495 | $1,276 | 117% | — | 15 |
| Colonoscopy with polyp removal | $1,495 | $1,276 | 117% | — | 15 |
| Colonoscopy, diagnostic | $1,425 | $992 | 144% | — | 15 |
| Complete blood count with differential | $14 | $8 | 175% | — | 14 |
| Complete blood count, automated | $11 | $6 | 175% | — | 14 |
| Comprehensive metabolic panel | $18 | $11 | 175% | — | 14 |
| Diagnostic mammography, both breasts | $263 | — | — | — | 6 |
| Diagnostic mammography, one breast | $206 | — | — | — | 6 |
| ED visit, level 3 | $331 | $291 | 114% | — | 2 |
| ED visit, level 4 | $517 | $445 | 116% | — | 2 |
| ED visit, level 5 | $740 | $635 | 117% | — | 2 |
| Echocardiogram, complete | $655 | $583 | 112% | — | 2 |
| Electrocardiogram with interpretation | $26 | — | — | — | 1 |
| Epidural injection, lumbar/sacral, no imaging | $1,165 | $943 | 123% | — | 15 |
| Excision of breast lesion | $1,800 | $4,176 | 43% | — | 15 |
| Family psychotherapy, with patient | $269 | $189 | 142% | — | 2 |
| Family psychotherapy, without patient | $265 | $189 | 140% | — | 2 |
| Group psychotherapy | $122 | $108 | 113% | — | 2 |
| Inguinal hernia repair, age 5+ | $2,521 | $3,819 | 66% | — | 15 |
| Kidney function panel | $15 | $9 | 175% | — | 14 |
| Knee arthroscopy with meniscectomy | $2,521 | $3,490 | 72% | — | 15 |
| Laparoscopic cholecystectomy | $4,443 | $6,448 | 69% | — | 15 |
| Laparoscopic radical prostatectomy | $4,012 | $11,338 | 35% | — | 15 |
| Left heart catheterization, diagnostic | $4,124 | $3,458 | 119% | — | 15 |
| Lipid panel | $23 | $13 | 175% | — | 14 |
| Liver function panel | $14 | $8 | 175% | — | 14 |
| Lumbar epidural steroid injection | $1,165 | $753 | 155% | — | 15 |
| MRI brain with and without contrast | $828 | $372 | 223% | — | 6 |
| MRI lower extremity joint (knee) | $518 | $254 | 203% | — | 6 |
| MRI lumbar spine without contrast | $518 | $254 | 203% | — | 6 |
| OB global care, VBAC delivery | $3,281 | — | — | — | 10 |
| OB global care, cesarean delivery | $3,281 | — | — | — | 10 |
| OB global care, vaginal delivery | $3,281 | — | — | — | 10 |
| OB ultrasound, 14+ weeks | $245 | $112 | 220% | — | 6 |
| Obstetric blood test panel | $84 | $48 | 175% | — | 14 |
| Office visit, established patient, level 3 | $116 | — | — | — | 1 |
| Office visit, established patient, level 4 | $171 | — | — | — | 1 |
| Office visit, new patient, level 3 | $144 | — | — | — | 1 |
| Office visit, new patient, level 4 | $235 | — | — | — | 1 |
| Office visit, new patient, level 5 | $320 | — | — | — | 1 |
| PSA (prostate specific antigen), total | $32 | $18 | 175% | — | 14 |
| Partial thromboplastin time | $11 | $6 | 175% | — | 14 |
| Physical therapy, therapeutic exercise | $54 | — | — | — | 2 |
| Prostate biopsy | $1,460 | — | — | — | 14 |
| Prothrombin time | $8 | $4 | 175% | — | 14 |
| Psychotherapy, 30 minutes | $238 | $189 | 126% | — | 2 |
| Psychotherapy, 45 minutes | $258 | $189 | 136% | — | 2 |
| Psychotherapy, 60 minutes | $298 | $189 | 157% | — | 2 |
| Screening mammography, bilateral | $217 | — | — | — | 6 |
| Shoulder arthroscopy, subacromial decompression | $1,691 | — | — | — | 14 |
| Sleep study (polysomnography) | $1,318 | $916 | 144% | — | 2 |
| Thyroid stimulating hormone (TSH) | $29 | $17 | 175% | — | 14 |
| Tonsillectomy and adenoidectomy, under age 12 | $1,800 | $6,314 | 29% | — | 15 |
| Transforaminal epidural, lumbar/sacral | $1,165 | $943 | 123% | — | 15 |
| Ultrasound, abdomen, complete | $245 | $112 | 220% | — | 6 |
| Ultrasound, transvaginal | $245 | $112 | 220% | — | 6 |
| Upper GI endoscopy with biopsy | $1,425 | $967 | 147% | — | 15 |
| Upper GI endoscopy, diagnostic | $1,165 | $967 | 120% | — | 15 |
| Urinalysis, automated, with microscopy | $6 | $3 | 175% | — | 14 |
| Urinalysis, automated, without microscopy | $4 | $2 | 175% | — | 14 |
| Urinalysis, manual, with microscopy | $7 | $4 | 175% | — | 14 |
| Urinalysis, manual, without microscopy | $6 | $3 | 175% | — | 14 |
| X-ray, lower back, 4+ views | $245 | $112 | 220% | — | 6 |
| YAG laser capsulotomy (secondary cataract) | $1,368 | $587 | 233% | — | 15 |