| Basic metabolic panelCPT 80048 | $11 | $8 | 125% | — | 1 |
| CT abdomen and pelvis with contrastCPT 74177 | $433 | $346 | 125% | — | 1 |
| CT head without contrastCPT 70450 | $130 | $104 | 125% | — | 1 |
| CT pelvis with contrastCPT 72193 | $217 | $174 | 125% | — | 1 |
| Cardiac stress testCPT 93017 | $268 | $214 | 125% | — | 1 |
| Colonoscopy with biopsyCPT 45380 | $1,484 | $1,187 | 125% | — | 1 |
| Colonoscopy with endoscopic ultrasoundCPT 45391 | $1,484 | $1,187 | 125% | — | 1 |
| Colonoscopy with polyp removalCPT 45385 | $1,484 | $1,187 | 125% | — | 1 |
| Colonoscopy, diagnosticCPT 45378 | $1,153 | $922 | 125% | — | 1 |
| Complete blood count with differentialCPT 85025 | $10 | $8 | 125% | — | 1 |
| Complete blood count, automatedCPT 85027 | $8 | $6 | 125% | — | 1 |
| Comprehensive metabolic panelCPT 80053 | $13 | $11 | 125% | — | 1 |
| Diagnostic mammography, both breastsCPT 77066 | $127 | — | — | — | 1 |
| Diagnostic mammography, one breastCPT 77065 | $99 | — | — | — | 1 |
| ED visit, level 3CPT 99283 | $338 | $271 | 125% | — | 1 |
| ED visit, level 4CPT 99284 | $517 | $414 | 125% | — | 1 |
| ED visit, level 5CPT 99285 | $738 | $591 | 125% | — | 1 |
| Echocardiogram, completeCPT 93306 | $678 | $542 | 125% | — | 1 |
| Epidural injection, lumbar/sacral, no imagingCPT 62322 | $1,097 | $877 | 125% | — | 1 |
| Excision of breast lesionCPT 19120 | $4,855 | $3,884 | 125% | — | 1 |
| Inguinal hernia repair, age 5+CPT 49505 | $4,439 | $3,552 | 125% | — | 1 |
| Kidney function panelCPT 80069 | $11 | $9 | 125% | — | 1 |
| Knee arthroscopy with meniscectomyCPT 29881 | $4,057 | $3,246 | 125% | — | 1 |
| Laparoscopic cholecystectomyCPT 47562 | $7,496 | $5,997 | 125% | — | 1 |
| Laparoscopic radical prostatectomyCPT 55866 | $13,180 | $10,544 | 125% | — | 1 |
| Lipid panelCPT 80061 | $17 | $13 | 125% | — | 1 |
| Liver function panelCPT 80076 | $10 | $8 | 125% | — | 1 |
| Lumbar epidural steroid injectionCPT 62323 | $875 | $700 | 125% | — | 1 |
| MRI brain with and without contrastCPT 70553 | $433 | $346 | 125% | — | 1 |
| MRI lower extremity joint (knee)CPT 73721 | $296 | $237 | 125% | — | 1 |
| MRI lumbar spine without contrastCPT 72148 | $296 | $237 | 125% | — | 1 |
| OB ultrasound, 14+ weeksCPT 76805 | $130 | $104 | 125% | — | 1 |
| Obstetric blood test panelCPT 80055 | $60 | $48 | 125% | — | 1 |
| PSA (prostate specific antigen), totalCPT 84153 | $23 | $18 | 125% | — | 1 |
| Partial thromboplastin timeCPT 85730 | $8 | $6 | 125% | — | 1 |
| Physical therapy, therapeutic exerciseCPT 97110 | $35 | — | — | — | 1 |
| Prothrombin timeCPT 85610 | $5 | $4 | 125% | — | 1 |
| Screening mammography, bilateralCPT 77067 | $105 | — | — | — | 1 |
| Thyroid stimulating hormone (TSH)CPT 84443 | $21 | $17 | 125% | — | 1 |
| Transforaminal epidural, lumbar/sacralCPT 64483 | $1,097 | $877 | 125% | — | 1 |
| Ultrasound, abdomen, completeCPT 76700 | $130 | $104 | 125% | — | 1 |
| Ultrasound, transvaginalCPT 76830 | $130 | $104 | 125% | — | 1 |
| Upper GI endoscopy with biopsyCPT 43239 | $1,125 | $900 | 125% | — | 1 |
| Upper GI endoscopy, diagnosticCPT 43235 | $1,125 | $900 | 125% | — | 1 |
| Urinalysis, automated, with microscopyCPT 81001 | $4 | $3 | 125% | — | 1 |
| Urinalysis, automated, without microscopyCPT 81003 | $3 | $2 | 125% | — | 1 |
| Urinalysis, manual, with microscopyCPT 81000 | $5 | $4 | 125% | — | 1 |
| Urinalysis, manual, without microscopyCPT 81002 | $4 | $3 | 125% | — | 1 |
| X-ray, lower back, 4+ viewsCPT 72110 | $130 | $104 | 125% | — | 1 |