| CT scan, lower back (lumbar spine) CPT Code: 72131 | $1,002 | — | — | — |
| CT scan, sinuses CPT Code: 70486 | $934 | — | — | — |
| Occupational therapy (self-care training) CPT Code: 97535 | $60 | — | — | — |
| Blood test, vitamin D CPT Code: 82306 | $59 | — | — | — |
| Ultrasound, pelvis CPT Code: 76856 | $341 | — | — | — |
| X-ray, lower back CPT Code: 72110 | $214 | — | — | — |
| Ultrasound, abdomen (complete) CPT Code: 76700 | $389 | — | — | — |
| Sleep study (overnight, in lab) CPT Code: 95810 | $1,744 | — | — | — |
| Trauma team activation HCPCS Code: G0390 | $1,620 | — | — | — |
| Total knee replacement CPT Code: 27447 | $2,874 | — | — | — |
| Neurobehavioral status check CPT Code: 96116 | $230 | — | — | — |
| MRI, brain (no contrast) CPT Code: 70551 | $1,861 | — | — | — |
| Screening mammogram (both breasts) CPT Code: 77067 | $196 | — | — | — |
| Upper endoscopy with biopsy CPT Code: 43239 | $1,904 | — | — | — |
| Speech therapy (language evaluation) CPT Code: 92507 | $152 | — | — | — |
| CT scan, head (no contrast) CPT Code: 70450 | $942 | — | — | — |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $734 | — | — | — |
| Physical therapy (functional capacity test) CPT Code: 97750 | $69 | — | — | — |
| Electrocardiogram (EKG, tracing only) CPT Code: 93005 | $165 | — | — | — |
| Rabies immune globulin HCPCS Code: 90375 | $639 | — | — | — |
| X-ray, hand CPT Code: 73130 | $136 | — | — | — |
| Group therapy session CPT Code: 90853 | $126 | — | — | — |
| Colonoscopy with biopsy CPT Code: 45380 | $1,814 | — | — | — |
| Physical therapy (manual therapy) CPT Code: 97140 | $60 | — | — | — |
| CT scan, head (with and without contrast) CPT Code: 70470 | $1,117 | — | — | — |
| MRI, knee or other leg joint CPT Code: 73721 | $1,861 | — | — | — |
| X-ray, shoulder CPT Code: 73030 | $146 | — | — | — |
| Occupational therapy (therapeutic activities) CPT Code: 97530 | $60 | — | — | — |
| Physical therapy (therapeutic exercise) CPT Code: 97110 | $60 | — | — | — |
| CT scan, pelvis CPT Code: 72192 | $934 | — | — | — |
| Ultrasound, abdomen (limited) CPT Code: 76705 | $292 | — | — | — |
| Breathing treatment (nebulizer) CPT Code: 94640 | $92 | — | — | — |
| X-ray, ankle CPT Code: 73610 | $145 | — | — | — |
| New patient office visit (30-44 min) CPT Code: 99203 | $164 | — | — | — |
| MRI, lower back (no contrast) CPT Code: 72148 | $1,719 | — | — | — |
| X-ray, neck (cervical spine) CPT Code: 72040 | $136 | — | — | — |
| Office visit, established patient (20-29 min) CPT Code: 99213 | $111 | — | — | — |
| Speech therapy (group session) CPT Code: 92508 | $37 | — | — | — |
| Total hip replacement CPT Code: 27130 | $2,876 | — | — | — |
| CT scan, head (with contrast) CPT Code: 70460 | $1,032 | — | — | — |
| Ultrasound, leg veins (duplex) CPT Code: 93970 | $590 | — | — | — |
| X-ray, chest (single view) CPT Code: 71045 | $132 | — | — | — |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $1,146 | — | — | — |
| Ultrasound, thyroid and neck CPT Code: 76536 | $316 | — | — | — |
| X-ray, pelvis CPT Code: 72170 | $132 | — | — | — |
| X-ray, chest (two views) CPT Code: 71046 | $156 | — | — | — |
| Prosthetic fitting and training CPT Code: 97761 | $60 | — | — | — |
| Physical therapy (gait training) CPT Code: 97116 | $50 | — | — | — |
| Blood transfusion CPT Code: 36430 | $459 | — | — | — |
| X-ray, foot CPT Code: 73630 | $145 | — | — | — |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $2,430 | — | — | — |
| MRI, brain (with and without contrast) CPT Code: 70553 | $3,007 | — | — | — |
| Flu vaccine (high dose) HCPCS Code: 90656 | $27 | — | — | — |
| Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: 90715 | $181 | — | — | — |
| Office visit, established patient (30-39 min) CPT Code: 99214 | $170 | — | — | — |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $2,700 | — | — | — |
| Colonoscopy (diagnostic) CPT Code: 45378 | $1,814 | — | — | — |
| Orthotic fitting and training CPT Code: 97760 | $60 | — | — | — |
| X-ray, hip CPT Code: 73502 | $136 | — | — | — |
| Typhoid vaccine HCPCS Code: 90675 | $935 | — | — | — |
| Diagnostic mammogram (both breasts) CPT Code: 77066 | $234 | — | — | — |
| CT scan, chest (no contrast) CPT Code: 71250 | $1,032 | — | — | — |
| Physical therapy (neuromuscular re-education) CPT Code: 97112 | $55 | — | — | — |
| CT scan, neck (cervical spine) CPT Code: 72125 | $934 | — | — | — |