| Basic metabolic panelCPT 80048 | $12 | $8 | 140% | ~$4 | 12 |
| CT abdomen and pelvis with contrastCPT 74177 | $3,462 | $435 | 795% | ~$822 | 12 |
| CT head without contrastCPT 70450 | $1,358 | $130 | 1041% | ~$322 | 12 |
| CT pelvis with contrastCPT 72193 | $2,011 | $219 | 919% | ~$477 | 12 |
| Colonoscopy with biopsyCPT 45380 | $533 | $1,494 | 36% | $210 | 12 |
| Colonoscopy with polyp removalCPT 45385 | $632 | $1,494 | 42% | $217 | 12 |
| Colonoscopy, diagnosticCPT 45378 | $486 | $1,161 | 42% | $162 | 12 |
| Complete blood count with differentialCPT 85025 | $15 | $8 | 192% | ~$4 | 12 |
| Complete blood count, automatedCPT 85027 | $8 | $6 | 128% | ~$2 | 12 |
| Comprehensive metabolic panelCPT 80053 | $14 | $11 | 133% | ~$4 | 12 |
| Diagnostic mammography, both breastsCPT 77066 | $341 | — | — | ~$81 | 12 |
| Diagnostic mammography, one breastCPT 77065 | $291 | — | — | ~$64 | 12 |
| ED visit, level 3CPT 99283 | $284 | $341 | 83% | $22 | 12 |
| ED visit, level 4CPT 99284 | $849 | $521 | 163% | $201 | 12 |
| ED visit, level 5CPT 99285 | $757 | $743 | 102% | $53 | 12 |
| Echocardiogram, completeCPT 93306 | $1,582 | $682 | 232% | $375 | 12 |
| Electrocardiogram with interpretationCPT 93000 | $27 | — | — | $7 | 12 |
| Epidural injection, lumbar/sacral, no imagingCPT 62322 | $176 | $1,104 | 16% | $50 | 12 |
| Excision of breast lesionCPT 19120 | $670 | $4,888 | 14% | $179 | 12 |
| Family psychotherapy, with patientCPT 90847 | $135 | $222 | 61% | $16 | 12 |
| Family psychotherapy, without patientCPT 90846 | $143 | $222 | 65% | $22 | 12 |
| Group psychotherapyCPT 90853 | $41 | $127 | 32% | $21 | 12 |
| Inguinal hernia repair, age 5+CPT 49505 | $903 | $4,469 | 20% | $229 | 12 |
| Kidney function panelCPT 80069 | $11 | $9 | 131% | ~$3 | 12 |
| Knee arthroscopy with meniscectomyCPT 29881 | $1,096 | $4,084 | 27% | $239 | 12 |
| Laparoscopic cholecystectomyCPT 47562 | $1,267 | $7,547 | 17% | $288 | 12 |
| Laparoscopic radical prostatectomyCPT 55866 | $2,379 | $13,269 | 18% | $609 | 12 |
| Lipid panelCPT 80061 | $16 | $13 | 121% | ~$3 | 12 |
| Liver function panelCPT 80076 | $11 | $8 | 139% | ~$3 | 12 |
| Lumbar epidural steroid injectionCPT 62323 | $249 | $881 | 28% | $96 | 12 |
| MRI brain with and without contrastCPT 70553 | $4,417 | $435 | 1014% | ~$1,048 | 12 |
| MRI lower extremity joint (knee)CPT 73721 | $2,271 | $298 | 762% | ~$539 | 12 |
| MRI lumbar spine without contrastCPT 72148 | $3,182 | $298 | 1068% | ~$602 | 10 |
| Major joint replacement (hip/knee), no MCCMS-DRG 470 | $27,043 | $14,348 | 188% | $10,802 | 3 |
| OB global care, VBAC deliveryCPT 59610 | $3,150 | — | — | $710 | 12 |
| OB global care, cesarean deliveryCPT 59510 | $3,437 | — | — | $753 | 12 |
| OB global care, vaginal deliveryCPT 59400 | $3,017 | — | — | $854 | 12 |
| OB ultrasound, 14+ weeksCPT 76805 | $373 | $130 | 286% | ~$126 | 12 |
| Obstetric blood test panelCPT 80055 | $53 | $48 | 111% | ~$10 | 12 |
| Office consultation, comprehensiveCPT 99244 | $262 | — | — | $100 | 10 |
| Office consultation, moderateCPT 99243 | $180 | — | — | $68 | 10 |
| Office visit, established patient, level 3CPT 99213 | $93 | — | — | $22 | 12 |
| Office visit, established patient, level 4CPT 99214 | $137 | — | — | $31 | 12 |
| Office visit, new patient, level 3CPT 99203 | $118 | — | — | $27 | 12 |
| Office visit, new patient, level 4CPT 99204 | $192 | — | — | $40 | 12 |
| Office visit, new patient, level 5CPT 99205 | $257 | — | — | $53 | 12 |
| PSA (prostate specific antigen), totalCPT 84153 | $33 | $18 | 181% | ~$8 | 12 |
| Partial thromboplastin timeCPT 85730 | $8 | $6 | 134% | ~$2 | 12 |
| Physical therapy, therapeutic exerciseCPT 97110 | $108 | — | — | $20 | 12 |
| Preventive visit, new patient, 18-39CPT 99385 | $112 | — | — | $43 | 11 |
| Preventive visit, new patient, 40-64CPT 99386 | $129 | — | — | $36 | 12 |
| Prostate biopsyCPT 55700 | $301 | — | — | $94 | 12 |
| Prothrombin timeCPT 85610 | $6 | $4 | 150% | ~$1 | 12 |
| Psychotherapy, 30 minutesCPT 90832 | $100 | $222 | 45% | $17 | 12 |
| Psychotherapy, 45 minutesCPT 90834 | $101 | $222 | 46% | $15 | 12 |
| Psychotherapy, 60 minutesCPT 90837 | $149 | $222 | 67% | $22 | 12 |
| Screening mammography, bilateralCPT 77067 | $314 | — | — | ~$73 | 12 |
| Shoulder arthroscopy, subacromial decompressionCPT 29826 | $401 | — | — | $74 | 12 |
| Thyroid stimulating hormone (TSH)CPT 84443 | $21 | $17 | 123% | ~$4 | 12 |
| Tonsillectomy and adenoidectomy, under age 12CPT 42820 | $548 | $7,390 | 7% | $128 | 12 |
| Transforaminal epidural, lumbar/sacralCPT 64483 | $333 | $1,104 | 30% | $92 | 12 |
| Ultrasound, abdomen, completeCPT 76700 | $278 | $130 | 213% | ~$52 | 12 |
| Ultrasound, transvaginalCPT 76830 | $309 | $130 | 237% | ~$54 | 12 |
| Upper GI endoscopy with biopsyCPT 43239 | $363 | $1,132 | 32% | $171 | 12 |
| Upper GI endoscopy, diagnosticCPT 43235 | $325 | $1,132 | 29% | $133 | 12 |
| Urinalysis, automated, with microscopyCPT 81001 | $6 | $3 | 203% | ~$2 | 12 |
| Urinalysis, automated, without microscopyCPT 81003 | $4 | $2 | 179% | ~$1 | 10 |
| Urinalysis, manual, with microscopyCPT 81000 | $10 | $4 | 241% | ~$2 | 12 |
| Urinalysis, manual, without microscopyCPT 81002 | $8 | $3 | 231% | ~$2 | 10 |
| X-ray, lower back, 4+ viewsCPT 72110 | $129 | $130 | 99% | ~$58 | 12 |