| Basic metabolic panel | $170 | $8 | 2009% | — | 5 |
| CT abdomen and pelvis with contrast | $3,604 | $356 | 1011% | — | 5 |
| CT head without contrast | $2,390 | $107 | 2238% | — | 5 |
| CT pelvis with contrast | $2,689 | $179 | 1501% | — | 5 |
| Colonoscopy with biopsy | $3,419 | $1,223 | 280% | — | 5 |
| Colonoscopy with polyp removal | $3,419 | $1,223 | 280% | — | 5 |
| Colonoscopy, diagnostic | $2,941 | $950 | 310% | — | 5 |
| Complete blood count with differential | $123 | $8 | 1583% | — | 5 |
| Complete blood count, automated | $111 | $6 | 1716% | — | 5 |
| Comprehensive metabolic panel | $209 | $11 | 1979% | — | 5 |
| ED visit, level 3 | $972 | $279 | 349% | — | 5 |
| ED visit, level 4 | $1,173 | $426 | 275% | — | 5 |
| ED visit, level 5 | $2,506 | $608 | 412% | — | 5 |
| Echocardiogram, complete | $2,461 | $558 | 441% | — | 5 |
| Electrocardiogram with interpretation | $220 | — | — | — | 5 |
| Kidney function panel | $296 | $9 | 3410% | — | 5 |
| Lipid panel | $146 | $13 | 1090% | — | 5 |
| Liver function panel | $163 | $8 | 1995% | — | 5 |
| Lumbar epidural steroid injection | $638 | $721 | 88% | — | 5 |
| MRI brain with and without contrast | $3,847 | $356 | 1079% | — | 5 |
| MRI lower extremity joint (knee) | $3,286 | $244 | 1348% | — | 5 |
| MRI lumbar spine without contrast | $3,272 | $244 | 1342% | — | 5 |
| OB ultrasound, 14+ weeks | $886 | $107 | 830% | — | 5 |
| Obstetric blood test panel | $420 | $48 | 878% | — | 5 |
| Office consultation, comprehensive | $291 | — | — | — | 5 |
| Office consultation, moderate | $225 | — | — | — | 5 |
| Office visit, established patient, level 3 | $94 | — | — | — | 5 |
| Office visit, established patient, level 4 | $173 | — | — | — | 5 |
| Office visit, new patient, level 3 | $93 | — | — | — | 5 |
| Office visit, new patient, level 4 | $256 | — | — | — | 5 |
| Office visit, new patient, level 5 | $330 | — | — | — | 5 |
| PSA (prostate specific antigen), total | $153 | $18 | 832% | — | 5 |
| Partial thromboplastin time | $129 | $6 | 2146% | — | 5 |
| Physical therapy, therapeutic exercise | $122 | — | — | — | 5 |
| Preventive visit, new patient, 18-39 | $236 | — | — | — | 5 |
| Preventive visit, new patient, 40-64 | $258 | — | — | — | 5 |
| Prothrombin time | $120 | $4 | 2797% | — | 5 |
| Psychotherapy, 30 minutes | $198 | $181 | 109% | — | 5 |
| Psychotherapy, 45 minutes | $262 | $181 | 144% | — | 5 |
| Psychotherapy, 60 minutes | $385 | $181 | 212% | — | 5 |
| Sleep study (polysomnography) | $4,353 | $877 | 496% | — | 5 |
| Thyroid stimulating hormone (TSH) | $149 | $17 | 887% | — | 5 |
| Transforaminal epidural, lumbar/sacral | $2,619 | $904 | 290% | — | 5 |
| Ultrasound, abdomen, complete | $857 | $107 | 802% | — | 5 |
| Ultrasound, transvaginal | $861 | $107 | 806% | — | 5 |
| Upper GI endoscopy with biopsy | $1,752 | $927 | 189% | — | 5 |
| Upper GI endoscopy, diagnostic | $872 | $927 | 94% | — | 5 |
| Urinalysis, automated, with microscopy | $79 | $3 | 2492% | — | 5 |
| Urinalysis, automated, without microscopy | $52 | $2 | 2311% | — | 5 |
| Urinalysis, manual, with microscopy | $21 | $4 | 522% | — | 5 |
| Urinalysis, manual, without microscopy | $22 | $3 | 632% | — | 5 |
| X-ray, lower back, 4+ views | $702 | $107 | 657% | — | 5 |