| Basic metabolic panelCPT 80048 | $8 | $8 | 99% | — | 16 |
| COPD with MCCMS-DRG 190 | $255 | $7,377 | 3% | — | 11 |
| CT abdomen and pelvis with contrastCPT 74177 | $427 | $356 | 120% | — | 16 |
| CT head without contrastCPT 70450 | $153 | $107 | 143% | — | 16 |
| CT pelvis with contrastCPT 72193 | $313 | $179 | 175% | — | 16 |
| Cardiac stress testCPT 93017 | $46 | $221 | 21% | — | 16 |
| Cardiac valve surgery with cardiac cath, with MCCMS-DRG 216 | $765 | — | — | — | 11 |
| Cataract surgery with IOL insertionCPT 66984 | $841 | $2,358 | 36% | — | 16 |
| Colonoscopy with biopsyCPT 45380 | $279 | $1,223 | 23% | — | 16 |
| Colonoscopy with endoscopic ultrasoundCPT 45391 | $359 | $1,223 | 29% | — | 16 |
| Colonoscopy with polyp removalCPT 45385 | $354 | $1,223 | 29% | — | 16 |
| Colonoscopy, diagnosticCPT 45378 | $257 | $950 | 27% | — | 16 |
| Complete blood count with differentialCPT 85025 | $8 | $8 | 98% | — | 16 |
| Complete blood count, automatedCPT 85027 | $6 | $6 | 98% | — | 16 |
| Comprehensive metabolic panelCPT 80053 | $10 | $11 | 99% | — | 16 |
| Diagnostic mammography, both breastsCPT 77066 | $218 | — | — | — | 16 |
| Diagnostic mammography, one breastCPT 77065 | $173 | — | — | — | 16 |
| ED visit, level 3CPT 99283 | $83 | $279 | 30% | — | 16 |
| ED visit, level 4CPT 99284 | $158 | $426 | 37% | — | 16 |
| ED visit, level 5CPT 99285 | $232 | $608 | 38% | — | 16 |
| Echocardiogram, completeCPT 93306 | $277 | $558 | 50% | — | 16 |
| Electrocardiogram with interpretationCPT 93000 | $22 | — | — | — | 16 |
| Epidural injection, lumbar/sacral, no imagingCPT 62322 | $114 | $904 | 13% | — | 16 |
| Excision of breast lesionCPT 19120 | $565 | $4,000 | 14% | — | 16 |
| Family psychotherapy, with patientCPT 90847 | $138 | $181 | 76% | — | 16 |
| Family psychotherapy, without patientCPT 90846 | $129 | $181 | 71% | — | 16 |
| Group psychotherapyCPT 90853 | $33 | $104 | 32% | — | 16 |
| Inguinal hernia repair, age 5+CPT 49505 | $716 | $3,658 | 20% | — | 16 |
| Kidney function panelCPT 80069 | $9 | $9 | 99% | — | 16 |
| Knee arthroscopy with meniscectomyCPT 29881 | $740 | $3,343 | 22% | — | 16 |
| Laparoscopic cholecystectomyCPT 47562 | $906 | $6,176 | 15% | — | 16 |
| Laparoscopic radical prostatectomyCPT 55866 | $1,942 | $10,860 | 18% | — | 15 |
| Left heart catheterization, diagnosticCPT 93452 | $1,168 | $3,312 | 35% | — | 16 |
| Lipid panelCPT 80061 | $13 | $13 | 99% | — | 16 |
| Liver function panelCPT 80076 | $8 | $8 | 99% | — | 16 |
| Lumbar epidural steroid injectionCPT 62323 | $135 | $721 | 19% | — | 16 |
| MRI brain with and without contrastCPT 70553 | $489 | $356 | 137% | — | 16 |
| MRI lower extremity joint (knee)CPT 73721 | $307 | $244 | 126% | — | 16 |
| MRI lumbar spine without contrastCPT 72148 | $291 | $244 | 119% | — | 16 |
| Major joint replacement (hip/knee), no MCCMS-DRG 470 | $306 | $13,045 | 2% | — | 11 |
| OB global care, VBAC deliveryCPT 59610 | $3,012 | — | — | — | 16 |
| OB global care, cesarean deliveryCPT 59510 | $3,182 | — | — | — | 16 |
| OB global care, vaginal deliveryCPT 59400 | $2,870 | — | — | — | 16 |
| OB ultrasound, 14+ weeksCPT 76805 | $185 | $107 | 173% | — | 16 |
| Obstetric blood test panelCPT 80055 | $47 | $48 | 99% | — | 16 |
| Office consultation, comprehensiveCPT 99244 | $206 | — | — | — | 14 |
| Office consultation, moderateCPT 99243 | $128 | — | — | — | 14 |
| Office visit, established patient, level 3CPT 99213 | $68 | — | — | — | 16 |
| Office visit, established patient, level 4CPT 99214 | $105 | — | — | — | 16 |
| Office visit, new patient, level 3CPT 99203 | $102 | — | — | — | 16 |
| Office visit, new patient, level 4CPT 99204 | $172 | — | — | — | 16 |
| Office visit, new patient, level 5CPT 99205 | $226 | — | — | — | 16 |
| PSA (prostate specific antigen), totalCPT 84153 | $18 | $18 | 99% | — | 16 |
| Partial thromboplastin timeCPT 85730 | $6 | $6 | 99% | — | 16 |
| Physical therapy, therapeutic exerciseCPT 97110 | $29 | — | — | — | 16 |
| Preventive visit, new patient, 18-39CPT 99385 | $131 | — | — | — | 16 |
| Preventive visit, new patient, 40-64CPT 99386 | $160 | — | — | — | 16 |
| Prostate biopsyCPT 55700 | $177 | — | — | — | 16 |
| Prothrombin timeCPT 85610 | $4 | $4 | 92% | — | 16 |
| Psychotherapy, 30 minutesCPT 90832 | $81 | $181 | 45% | — | 16 |
| Psychotherapy, 45 minutesCPT 90834 | $112 | $181 | 62% | — | 16 |
| Psychotherapy, 60 minutesCPT 90837 | $163 | $181 | 90% | — | 16 |
| Screening mammography, bilateralCPT 77067 | $176 | — | — | — | 16 |
| Shoulder arthroscopy, subacromial decompressionCPT 29826 | $238 | — | — | — | 16 |
| Sleep study (polysomnography)CPT 95810 | $819 | $877 | 93% | — | 16 |
| Thyroid stimulating hormone (TSH)CPT 84443 | $17 | $17 | 99% | — | 16 |
| Tonsillectomy and adenoidectomy, under age 12CPT 42820 | $394 | $6,048 | 7% | — | 15 |
| Transforaminal epidural, lumbar/sacralCPT 64483 | $149 | $904 | 17% | — | 16 |
| Ultrasound, abdomen, completeCPT 76700 | $161 | $107 | 151% | — | 16 |
| Ultrasound, transvaginalCPT 76830 | $163 | $107 | 153% | — | 16 |
| Upper GI endoscopy with biopsyCPT 43239 | $192 | $927 | 21% | — | 16 |
| Upper GI endoscopy, diagnosticCPT 43235 | $170 | $927 | 18% | — | 16 |
| Urinalysis, automated, with microscopyCPT 81001 | $3 | $3 | 98% | — | 16 |
| Urinalysis, automated, without microscopyCPT 81003 | $2 | $2 | 98% | — | 16 |
| Urinalysis, manual, with microscopyCPT 81000 | $4 | $4 | 90% | — | 16 |
| Urinalysis, manual, without microscopyCPT 81002 | $3 | $3 | 90% | — | 16 |
| X-ray, lower back, 4+ viewsCPT 72110 | $68 | $107 | 64% | — | 16 |
| YAG laser capsulotomy (secondary cataract)CPT 66821 | $419 | $562 | 75% | — | 16 |