| Basic metabolic panel | $98 | $8 | 1158% | — | 12 |
| CT abdomen and pelvis with contrast | $1,254 | $356 | 352% | — | 12 |
| CT head without contrast | $714 | $107 | 669% | — | 12 |
| CT pelvis with contrast | $1,698 | $179 | 948% | — | 12 |
| Cardiac stress test | $1,438 | $221 | 652% | — | 12 |
| Complete blood count with differential | $40 | $8 | 515% | — | 12 |
| Complete blood count, automated | $49 | $6 | 751% | — | 12 |
| Comprehensive metabolic panel | $121 | $11 | 1145% | — | 12 |
| Diagnostic mammography, both breasts | $237 | — | — | — | 12 |
| Diagnostic mammography, one breast | $164 | — | — | — | 12 |
| ED visit, level 3 | $401 | $279 | 144% | — | 12 |
| ED visit, level 4 | $680 | $426 | 160% | — | 12 |
| ED visit, level 5 | $988 | $608 | 162% | — | 12 |
| Echocardiogram, complete | $2,612 | $558 | 468% | — | 12 |
| Epidural injection, lumbar/sacral, no imaging | $341 | $904 | 38% | — | 12 |
| Kidney function panel | $138 | $9 | 1586% | — | 12 |
| Lipid panel | $68 | $13 | 507% | — | 12 |
| Liver function panel | $95 | $8 | 1167% | — | 12 |
| Lumbar epidural steroid injection | $950 | $721 | 132% | — | 12 |
| MRI brain with and without contrast | $1,346 | $356 | 378% | — | 12 |
| MRI lower extremity joint (knee) | $245 | $244 | 101% | — | 12 |
| MRI lumbar spine without contrast | $850 | $244 | 349% | — | 12 |
| OB ultrasound, 14+ weeks | $510 | $107 | 477% | — | 12 |
| Office visit, established patient, level 3 | $266 | — | — | — | 12 |
| Office visit, established patient, level 4 | $356 | — | — | — | 12 |
| Office visit, new patient, level 3 | $297 | — | — | — | 12 |
| Office visit, new patient, level 4 | $410 | — | — | — | 12 |
| Office visit, new patient, level 5 | $468 | — | — | — | 12 |
| PSA (prostate specific antigen), total | $50 | $18 | 274% | — | 12 |
| Partial thromboplastin time | $33 | $6 | 547% | — | 12 |
| Physical therapy, therapeutic exercise | $112 | — | — | — | 12 |
| Prothrombin time | $12 | $4 | 273% | — | 12 |
| Screening mammography, bilateral | $200 | — | — | — | 12 |
| Thyroid stimulating hormone (TSH) | $73 | $17 | 434% | — | 12 |
| Transforaminal epidural, lumbar/sacral | $1,461 | $904 | 162% | — | 12 |
| Ultrasound, abdomen, complete | $564 | $107 | 528% | — | 12 |
| Ultrasound, transvaginal | $392 | $107 | 367% | — | 12 |
| Urinalysis, automated, with microscopy | $49 | $3 | 1531% | — | 12 |
| Urinalysis, automated, without microscopy | $6 | $2 | 280% | — | 12 |
| Urinalysis, manual, without microscopy | $10 | $3 | 284% | — | 12 |
| X-ray, lower back, 4+ views | $382 | $107 | 358% | — | 12 |