| Basic metabolic panel | $189 | $8 | 2237% | — | 111 |
| CT abdomen and pelvis with contrast | $4,977 | $356 | 1396% | — | 111 |
| CT head without contrast | $2,550 | $107 | 2387% | — | 111 |
| CT pelvis with contrast | $3,618 | $179 | 2019% | — | 111 |
| Cardiac stress test | $1,057 | $221 | 479% | — | 111 |
| Cataract surgery with IOL insertion | $3,631 | $2,358 | 154% | — | 111 |
| Colonoscopy with biopsy | $3,954 | $1,223 | 323% | — | 111 |
| Colonoscopy with endoscopic ultrasound | $1,121 | $1,223 | 92% | — | 111 |
| Colonoscopy with polyp removal | $3,289 | $1,223 | 269% | — | 111 |
| Colonoscopy, diagnostic | $1,588 | $950 | 167% | — | 111 |
| Complete blood count with differential | $125 | $8 | 1605% | — | 111 |
| Complete blood count, automated | $59 | $6 | 918% | — | 111 |
| Comprehensive metabolic panel | $144 | $11 | 1359% | — | 111 |
| Diagnostic mammography, both breasts | $250 | — | — | — | 111 |
| Diagnostic mammography, one breast | $443 | — | — | — | 111 |
| ED visit, level 3 | $807 | $279 | 289% | — | 111 |
| ED visit, level 4 | $1,196 | $426 | 281% | — | 111 |
| ED visit, level 5 | $1,780 | $608 | 293% | — | 111 |
| Echocardiogram, complete | $2,748 | $558 | 492% | — | 111 |
| Epidural injection, lumbar/sacral, no imaging | $1,015 | $904 | 112% | — | 111 |
| Excision of breast lesion | $1,842 | $4,000 | 46% | — | 111 |
| Inguinal hernia repair, age 5+ | $4,056 | $3,658 | 111% | — | 111 |
| Kidney function panel | $246 | $9 | 2834% | — | 111 |
| Knee arthroscopy with meniscectomy | $3,579 | $3,343 | 107% | — | 111 |
| Laparoscopic cholecystectomy | $7,599 | $6,176 | 123% | — | 111 |
| Lipid panel | $154 | $13 | 1150% | — | 111 |
| Liver function panel | $104 | $8 | 1267% | — | 111 |
| Lumbar epidural steroid injection | $823 | $721 | 114% | — | 111 |
| MRI brain with and without contrast | $5,092 | $356 | 1429% | — | 111 |
| MRI lower extremity joint (knee) | $3,257 | $244 | 1336% | — | 111 |
| MRI lumbar spine without contrast | $2,727 | $244 | 1119% | — | 111 |
| Office consultation, comprehensive | $338 | — | — | — | 109 |
| Office consultation, moderate | $306 | — | — | — | 109 |
| Office visit, established patient, level 3 | $152 | — | — | — | 109 |
| Office visit, established patient, level 4 | $277 | — | — | — | 109 |
| Office visit, new patient, level 3 | $262 | — | — | — | 109 |
| Office visit, new patient, level 4 | $405 | — | — | — | 109 |
| Office visit, new patient, level 5 | $620 | — | — | — | 109 |
| PSA (prostate specific antigen), total | $66 | $18 | 358% | — | 111 |
| Partial thromboplastin time | $521 | $6 | 8672% | — | 111 |
| Physical therapy, therapeutic exercise | $138 | — | — | — | 111 |
| Preventive visit, new patient, 18-39 | $311 | — | — | — | 111 |
| Preventive visit, new patient, 40-64 | $362 | — | — | — | 109 |
| Prothrombin time | $75 | $4 | 1759% | — | 111 |
| Screening mammography, bilateral | $453 | — | — | — | 111 |
| Shoulder arthroscopy, subacromial decompression | $730 | — | — | — | 111 |
| Sleep study (polysomnography) | $4,726 | $877 | 539% | — | 111 |
| Thyroid stimulating hormone (TSH) | $28 | $17 | 165% | — | 111 |
| Transforaminal epidural, lumbar/sacral | $437 | $904 | 48% | — | 111 |
| Ultrasound, abdomen, complete | $1,388 | $107 | 1300% | — | 111 |
| Ultrasound, transvaginal | $808 | $107 | 756% | — | 111 |
| Upper GI endoscopy with biopsy | $3,026 | $927 | 327% | — | 111 |
| Upper GI endoscopy, diagnostic | $558 | $927 | 60% | — | 111 |
| Urinalysis, automated, with microscopy | $100 | $3 | 3154% | — | 111 |
| Urinalysis, automated, without microscopy | $50 | $2 | 2222% | — | 111 |
| Urinalysis, manual, with microscopy | $85 | $4 | 2106% | — | 111 |
| Urinalysis, manual, without microscopy | $28 | $3 | 811% | — | 111 |
| X-ray, lower back, 4+ views | $792 | $107 | 742% | — | 111 |