| Basic metabolic panelCPT 80048 | $8 | $8 | 100% | — | 8 |
| CT abdomen and pelvis with contrastCPT 74177 | $337 | $435 | 77% | — | 3 |
| CT head without contrastCPT 70450 | $101 | $130 | 77% | — | 3 |
| CT pelvis with contrastCPT 72193 | $243 | $219 | 111% | — | 3 |
| Cardiac stress testCPT 93017 | $54 | $270 | 20% | — | 3 |
| Cataract surgery with IOL insertionCPT 66984 | $864 | $2,881 | 30% | — | 3 |
| Colonoscopy with biopsyCPT 45380 | $383 | $1,494 | 26% | — | 3 |
| Colonoscopy with endoscopic ultrasoundCPT 45391 | $493 | $1,494 | 33% | — | 3 |
| Colonoscopy with polyp removalCPT 45385 | $486 | $1,494 | 33% | — | 3 |
| Colonoscopy, diagnosticCPT 45378 | $352 | $1,161 | 30% | — | 3 |
| Complete blood count with differentialCPT 85025 | $7 | $8 | 93% | — | 8 |
| Complete blood count, automatedCPT 85027 | $6 | $6 | 100% | — | 8 |
| Comprehensive metabolic panelCPT 80053 | $11 | $11 | 100% | — | 8 |
| Diagnostic mammography, both breastsCPT 77066 | $205 | — | — | — | 4 |
| Diagnostic mammography, one breastCPT 77065 | $160 | — | — | — | 4 |
| ED visit, level 3CPT 99283 | $102 | $341 | 30% | — | 3 |
| ED visit, level 4CPT 99284 | $186 | $521 | 36% | — | 3 |
| ED visit, level 5CPT 99285 | $270 | $743 | 36% | — | 3 |
| Echocardiogram, completeCPT 93306 | $211 | $682 | 31% | — | 3 |
| Electrocardiogram with interpretationCPT 93000 | $24 | — | — | — | 3 |
| Epidural injection, lumbar/sacral, no imagingCPT 62322 | $120 | $1,104 | 11% | — | 3 |
| Excision of breast lesionCPT 19120 | $579 | $4,888 | 12% | — | 3 |
| Family psychotherapy, with patientCPT 90847 | $143 | $222 | 65% | — | 5 |
| Family psychotherapy, without patientCPT 90846 | $138 | $222 | 62% | — | 5 |
| Group psychotherapyCPT 90853 | $60 | $127 | 48% | — | 5 |
| Inguinal hernia repair, age 5+CPT 49505 | $730 | $4,469 | 16% | — | 3 |
| Kidney function panelCPT 80069 | $9 | $9 | 100% | — | 8 |
| Knee arthroscopy with meniscectomyCPT 29881 | $762 | $4,084 | 19% | — | 3 |
| Laparoscopic cholecystectomyCPT 47562 | $924 | $7,547 | 12% | — | 3 |
| Laparoscopic radical prostatectomyCPT 55866 | $2,078 | $13,269 | 16% | — | 3 |
| Left heart catheterization, diagnosticCPT 93452 | $1,105 | $4,047 | 27% | — | 3 |
| Lipid panelCPT 80061 | $13 | $13 | 98% | — | 8 |
| Liver function panelCPT 80076 | $8 | $8 | 100% | — | 8 |
| Lumbar epidural steroid injectionCPT 62323 | $142 | $881 | 16% | — | 3 |
| MRI brain with and without contrastCPT 70553 | $388 | $435 | 89% | — | 3 |
| MRI lower extremity joint (knee)CPT 73721 | $249 | $298 | 84% | — | 3 |
| MRI lumbar spine without contrastCPT 72148 | $221 | $298 | 74% | — | 3 |
| OB global care, VBAC deliveryCPT 59610 | $2,821 | — | — | — | 3 |
| OB global care, cesarean deliveryCPT 59510 | $2,821 | — | — | — | 3 |
| OB global care, vaginal deliveryCPT 59400 | $2,821 | — | — | — | 3 |
| OB ultrasound, 14+ weeksCPT 76805 | $125 | $130 | 96% | — | 3 |
| Obstetric blood test panelCPT 80055 | $45 | $48 | 94% | — | 7 |
| Office consultation, comprehensiveCPT 99244 | $288 | — | — | — | 2 |
| Office consultation, moderateCPT 99243 | $192 | — | — | — | 2 |
| Office visit, established patient, level 3CPT 99213 | $66 | — | — | — | 5 |
| Office visit, established patient, level 4CPT 99214 | $168 | — | — | — | 5 |
| Office visit, new patient, level 3CPT 99203 | $167 | — | — | — | 5 |
| Office visit, new patient, level 4CPT 99204 | $256 | — | — | — | 5 |
| Office visit, new patient, level 5CPT 99205 | $323 | — | — | — | 5 |
| PSA (prostate specific antigen), totalCPT 84153 | $18 | $18 | 100% | — | 8 |
| Partial thromboplastin timeCPT 85730 | $6 | $6 | 100% | — | 8 |
| Physical therapy, therapeutic exerciseCPT 97110 | $43 | — | — | — | 7 |
| Preventive visit, new patient, 18-39CPT 99385 | $208 | — | — | — | 2 |
| Preventive visit, new patient, 40-64CPT 99386 | $240 | — | — | — | 2 |
| Prostate biopsyCPT 55700 | $188 | — | — | — | 2 |
| Prothrombin timeCPT 85610 | $4 | $4 | 100% | — | 8 |
| Psychotherapy, 30 minutesCPT 90832 | $101 | $222 | 46% | — | 5 |
| Psychotherapy, 45 minutesCPT 90834 | $134 | $222 | 61% | — | 5 |
| Psychotherapy, 60 minutesCPT 90837 | $202 | $222 | 91% | — | 5 |
| Screening mammography, bilateralCPT 77067 | $169 | — | — | — | 4 |
| Shoulder arthroscopy, subacromial decompressionCPT 29826 | $248 | — | — | — | 3 |
| Sleep study (polysomnography)CPT 95810 | $654 | $1,072 | 61% | — | 3 |
| Thyroid stimulating hormone (TSH)CPT 84443 | $17 | $17 | 100% | — | 8 |
| Tonsillectomy and adenoidectomy, under age 12CPT 42820 | $410 | $7,390 | 6% | — | 3 |
| Transforaminal epidural, lumbar/sacralCPT 64483 | $160 | $1,104 | 14% | — | 3 |
| Ultrasound, abdomen, completeCPT 76700 | $112 | $130 | 86% | — | 3 |
| Ultrasound, transvaginalCPT 76830 | $121 | $130 | 93% | — | 3 |
| Upper GI endoscopy with biopsyCPT 43239 | $228 | $1,132 | 20% | — | 3 |
| Upper GI endoscopy, diagnosticCPT 43235 | $201 | $1,132 | 18% | — | 3 |
| Urinalysis, automated, with microscopyCPT 81001 | $3 | $3 | 100% | — | 8 |
| Urinalysis, automated, without microscopyCPT 81003 | $2 | $2 | 100% | — | 8 |
| Urinalysis, manual, with microscopyCPT 81000 | $4 | $4 | 100% | — | 8 |
| Urinalysis, manual, without microscopyCPT 81002 | $3 | $3 | 100% | — | 8 |
| X-ray, lower back, 4+ viewsCPT 72110 | $50 | $130 | 39% | — | 3 |
| YAG laser capsulotomy (secondary cataract)CPT 66821 | $461 | $687 | 67% | — | 3 |