| Basic metabolic panelCPT 80048 | $15 | $8 | 175% | — | 20 |
| CT abdomen and pelvis with contrastCPT 74177 | $990 | $356 | 278% | — | 20 |
| CT head without contrastCPT 70450 | $480 | $107 | 450% | — | 10 |
| CT pelvis with contrastCPT 72193 | $480 | $179 | 268% | — | 10 |
| Cardiac stress testCPT 93017 | $356 | $221 | 162% | — | 10 |
| Colonoscopy with biopsyCPT 45380 | $1,474 | $1,223 | 121% | — | 10 |
| Colonoscopy with polyp removalCPT 45385 | $1,474 | $1,223 | 121% | — | 10 |
| Colonoscopy, diagnosticCPT 45378 | $1,321 | $950 | 139% | — | 10 |
| Complete blood count with differentialCPT 85025 | $8 | $8 | 105% | — | 20 |
| Complete blood count, automatedCPT 85027 | $11 | $6 | 175% | — | 20 |
| Comprehensive metabolic panelCPT 80053 | $18 | $11 | 175% | — | 20 |
| Diagnostic mammography, both breastsCPT 77066 | $123 | — | — | — | 10 |
| Diagnostic mammography, one breastCPT 77065 | $123 | — | — | — | 10 |
| ED visit, level 3CPT 99283 | $408 | $279 | 146% | — | 10 |
| ED visit, level 4CPT 99284 | $695 | $426 | 163% | — | 10 |
| ED visit, level 5CPT 99285 | $1,081 | $608 | 178% | — | 10 |
| Echocardiogram, completeCPT 93306 | $1,532 | $558 | 274% | — | 10 |
| Epidural injection, lumbar/sacral, no imagingCPT 62322 | $589 | $904 | 65% | — | 10 |
| Excision of breast lesionCPT 19120 | $4,787 | $4,000 | 120% | — | 10 |
| Inguinal hernia repair, age 5+CPT 49505 | $4,411 | $3,658 | 121% | — | 10 |
| Kidney function panelCPT 80069 | $15 | $9 | 175% | — | 20 |
| Knee arthroscopy with meniscectomyCPT 29881 | $4,056 | $3,343 | 121% | — | 10 |
| Laparoscopic cholecystectomyCPT 47562 | $7,293 | $6,176 | 118% | — | 10 |
| Laparoscopic radical prostatectomyCPT 55866 | $13,014 | $10,860 | 120% | — | 10 |
| Left heart catheterization, diagnosticCPT 93452 | $6,122 | $3,312 | 185% | — | 10 |
| Lipid panelCPT 80061 | $23 | $13 | 175% | — | 20 |
| Liver function panelCPT 80076 | $14 | $8 | 175% | — | 20 |
| Lumbar epidural steroid injectionCPT 62323 | $1,142 | $721 | 158% | — | 10 |
| MRI brain with and without contrastCPT 70553 | $1,026 | $356 | 288% | — | 20 |
| MRI lower extremity joint (knee)CPT 73721 | $553 | $244 | 227% | — | 10 |
| MRI lumbar spine without contrastCPT 72148 | $553 | $244 | 227% | — | 10 |
| OB ultrasound, 14+ weeksCPT 76805 | $133 | $107 | 124% | — | 10 |
| Office consultation, comprehensiveCPT 99244 | $161 | — | — | — | 6 |
| Office visit, established patient, level 3CPT 99213 | $133 | — | — | — | 10 |
| Office visit, established patient, level 4CPT 99214 | $189 | — | — | — | 10 |
| Office visit, new patient, level 3CPT 99203 | $101 | — | — | — | 10 |
| Office visit, new patient, level 4CPT 99204 | $101 | — | — | — | 10 |
| Office visit, new patient, level 5CPT 99205 | $169 | — | — | — | 10 |
| PSA (prostate specific antigen), totalCPT 84153 | $32 | $18 | 175% | — | 20 |
| Partial thromboplastin timeCPT 85730 | $10 | $6 | 174% | — | 20 |
| Physical therapy, therapeutic exerciseCPT 97110 | $57 | — | — | — | 10 |
| Prothrombin timeCPT 85610 | $7 | $4 | 160% | — | 20 |
| Screening mammography, bilateralCPT 77067 | $161 | — | — | — | 10 |
| Shoulder arthroscopy, subacromial decompressionCPT 29826 | $4,056 | — | — | — | 10 |
| Sleep study (polysomnography)CPT 95810 | $1,272 | $877 | 145% | — | 10 |
| Thyroid stimulating hormone (TSH)CPT 84443 | $29 | $17 | 175% | — | 20 |
| Tonsillectomy and adenoidectomy, under age 12CPT 42820 | $7,395 | $6,048 | 122% | — | 10 |
| Transforaminal epidural, lumbar/sacralCPT 64483 | $1,113 | $904 | 123% | — | 10 |
| Ultrasound, abdomen, completeCPT 76700 | $152 | $107 | 142% | — | 10 |
| Ultrasound, transvaginalCPT 76830 | $133 | $107 | 124% | — | 10 |
| Upper GI endoscopy with biopsyCPT 43239 | $1,172 | $927 | 126% | — | 10 |
| Upper GI endoscopy, diagnosticCPT 43235 | $1,172 | $927 | 126% | — | 10 |
| Urinalysis, automated, with microscopyCPT 81001 | $6 | $3 | 175% | — | 20 |
| Urinalysis, automated, without microscopyCPT 81003 | $4 | $2 | 175% | — | 20 |
| Urinalysis, manual, without microscopyCPT 81002 | $4 | $3 | 128% | — | 20 |
| X-ray, lower back, 4+ viewsCPT 72110 | $248 | $107 | 232% | — | 10 |