| Basic metabolic panelCPT 80048 | $10 | $8 | 115% | — | 22 |
| CT abdomen and pelvis with contrastCPT 74177 | $484 | $435 | 111% | — | 21 |
| CT head without contrastCPT 70450 | $185 | $130 | 142% | — | 21 |
| CT pelvis with contrastCPT 72193 | $311 | $219 | 142% | — | 21 |
| Cardiac stress testCPT 93017 | $260 | $270 | 97% | — | 21 |
| Cataract surgery with IOL insertionCPT 66984 | $2,893 | $2,881 | 100% | — | 21 |
| Colonoscopy with biopsyCPT 45380 | $1,613 | $1,494 | 108% | — | 21 |
| Colonoscopy with endoscopic ultrasoundCPT 45391 | $1,613 | $1,494 | 108% | — | 21 |
| Colonoscopy with polyp removalCPT 45385 | $1,613 | $1,494 | 108% | — | 21 |
| Colonoscopy, diagnosticCPT 45378 | $1,234 | $1,161 | 106% | — | 21 |
| Complete blood count with differentialCPT 85025 | $9 | $8 | 115% | — | 22 |
| Complete blood count, automatedCPT 85027 | $7 | $6 | 115% | — | 22 |
| Comprehensive metabolic panelCPT 80053 | $12 | $11 | 115% | — | 22 |
| Diagnostic mammography, both breastsCPT 77066 | $146 | — | — | — | 21 |
| Diagnostic mammography, one breastCPT 77065 | $115 | — | — | — | 21 |
| ED visit, level 3CPT 99283 | $308 | $341 | 90% | — | 21 |
| ED visit, level 4CPT 99284 | $473 | $521 | 91% | — | 21 |
| ED visit, level 5CPT 99285 | $690 | $743 | 93% | — | 21 |
| Echocardiogram, completeCPT 93306 | $684 | $682 | 100% | — | 21 |
| Electrocardiogram with interpretationCPT 93000 | $64 | — | — | — | 16 |
| Epidural injection, lumbar/sacral, no imagingCPT 62322 | $1,193 | $1,104 | 108% | — | 21 |
| Excision of breast lesionCPT 19120 | $4,303 | $4,888 | 88% | — | 21 |
| Family psychotherapy, with patientCPT 90847 | $287 | $222 | 130% | — | 21 |
| Family psychotherapy, without patientCPT 90846 | $257 | $222 | 116% | — | 21 |
| Group psychotherapyCPT 90853 | $125 | $127 | 99% | — | 21 |
| Inguinal hernia repair, age 5+CPT 49505 | $3,935 | $4,469 | 88% | — | 21 |
| Kidney function panelCPT 80069 | $10 | $9 | 115% | — | 22 |
| Knee arthroscopy with meniscectomyCPT 29881 | $3,596 | $4,084 | 88% | — | 21 |
| Laparoscopic cholecystectomyCPT 47562 | $6,644 | $7,547 | 88% | — | 21 |
| Laparoscopic radical prostatectomyCPT 55866 | $11,682 | $13,269 | 88% | — | 21 |
| Left heart catheterization, diagnosticCPT 93452 | $3,939 | $4,047 | 97% | — | 21 |
| Lipid panelCPT 80061 | $15 | $13 | 115% | — | 22 |
| Liver function panelCPT 80076 | $9 | $8 | 115% | — | 22 |
| Lumbar epidural steroid injectionCPT 62323 | $952 | $881 | 108% | — | 21 |
| MRI brain with and without contrastCPT 70553 | $618 | $435 | 142% | — | 21 |
| MRI lower extremity joint (knee)CPT 73721 | $423 | $298 | 142% | — | 21 |
| MRI lumbar spine without contrastCPT 72148 | $423 | $298 | 142% | — | 21 |
| OB global care, VBAC deliveryCPT 59610 | $3,717 | — | — | — | 10 |
| OB global care, cesarean deliveryCPT 59510 | $3,943 | — | — | — | 10 |
| OB global care, vaginal deliveryCPT 59400 | $3,561 | — | — | — | 10 |
| OB ultrasound, 14+ weeksCPT 76805 | $178 | $130 | 137% | — | 21 |
| Obstetric blood test panelCPT 80055 | $55 | $48 | 115% | — | 22 |
| Office consultation, comprehensiveCPT 99244 | $422 | — | — | — | 4 |
| Office consultation, moderateCPT 99243 | $299 | — | — | — | 4 |
| Office visit, established patient, level 3CPT 99213 | $121 | — | — | — | 16 |
| Office visit, established patient, level 4CPT 99214 | $185 | — | — | — | 16 |
| Office visit, new patient, level 3CPT 99203 | $161 | — | — | — | 16 |
| Office visit, new patient, level 4CPT 99204 | $261 | — | — | — | 16 |
| Office visit, new patient, level 5CPT 99205 | $355 | — | — | — | 16 |
| PSA (prostate specific antigen), totalCPT 84153 | $21 | $18 | 115% | — | 22 |
| Partial thromboplastin timeCPT 85730 | $7 | $6 | 115% | — | 22 |
| Physical therapy, therapeutic exerciseCPT 97110 | $40 | — | — | — | 21 |
| Preventive visit, new patient, 18-39CPT 99385 | $290 | — | — | — | 4 |
| Preventive visit, new patient, 40-64CPT 99386 | $342 | — | — | — | 4 |
| Prostate biopsyCPT 55700 | $491 | — | — | — | 10 |
| Prothrombin timeCPT 85610 | $5 | $4 | 115% | — | 22 |
| Psychotherapy, 30 minutesCPT 90832 | $195 | $222 | 88% | — | 21 |
| Psychotherapy, 45 minutesCPT 90834 | $215 | $222 | 97% | — | 21 |
| Psychotherapy, 60 minutesCPT 90837 | $242 | $222 | 109% | — | 21 |
| Screening mammography, bilateralCPT 77067 | $121 | — | — | — | 21 |
| Shoulder arthroscopy, subacromial decompressionCPT 29826 | $1,481 | — | — | — | 10 |
| Sleep study (polysomnography)CPT 95810 | $1,431 | $1,072 | 133% | — | 21 |
| Thyroid stimulating hormone (TSH)CPT 84443 | $19 | $17 | 115% | — | 22 |
| Tonsillectomy and adenoidectomy, under age 12CPT 42820 | $6,506 | $7,390 | 88% | — | 21 |
| Transforaminal epidural, lumbar/sacralCPT 64483 | $1,193 | $1,104 | 108% | — | 21 |
| Ultrasound, abdomen, completeCPT 76700 | $175 | $130 | 134% | — | 21 |
| Ultrasound, transvaginalCPT 76830 | $154 | $130 | 118% | — | 21 |
| Upper GI endoscopy with biopsyCPT 43239 | $1,257 | $1,132 | 111% | — | 21 |
| Upper GI endoscopy, diagnosticCPT 43235 | $1,223 | $1,132 | 108% | — | 21 |
| Urinalysis, automated, with microscopyCPT 81001 | $4 | $3 | 115% | — | 22 |
| Urinalysis, automated, without microscopyCPT 81003 | $3 | $2 | 115% | — | 22 |
| Urinalysis, manual, with microscopyCPT 81000 | $5 | $4 | 115% | — | 22 |
| Urinalysis, manual, without microscopyCPT 81002 | $4 | $3 | 115% | — | 22 |
| X-ray, lower back, 4+ viewsCPT 72110 | $130 | $130 | 100% | — | 21 |
| YAG laser capsulotomy (secondary cataract)CPT 66821 | $762 | $687 | 111% | — | 21 |