| Colorectal cancer screening (alternative) HCPCS Code: G0145 | $140 | — | — | — |
| Hepatitis C antibody test CPT Code: 86803 | $135 | — | — | — |
| MRI, knee or other leg joint CPT Code: 73721 | $2,810 | — | — | — |
| Typhoid vaccine HCPCS Code: 90675 | $513 | — | — | — |
| CT scan, head (with and without contrast) CPT Code: 70470 | $2,455 | — | — | — |
| Urinalysis (automated, with microscopy) CPT Code: 81001 | $40 | — | — | — |
| Blood test, magnesium CPT Code: 83735 | $50 | — | — | — |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $4,469 | — | — | — |
| CT scan, chest (no contrast) CPT Code: 71250 | $2,108 | — | — | — |
| X-ray, pelvis CPT Code: 72170 | $327 | — | — | — |
| MRI, lower back (no contrast) CPT Code: 72148 | $3,166 | — | — | — |
| Blood test, thyroid (TSH) CPT Code: 84443 | $124 | — | — | — |
| Blood antibody screen CPT Code: 86850 | $86 | — | — | — |
| Varicella (chickenpox) vaccine HCPCS Code: 90716 | $210 | — | — | — |
| Physical therapy (manual therapy) CPT Code: 97140 | $128 | — | — | — |
| CT scan, neck (cervical spine) CPT Code: 72125 | $2,474 | — | — | — |
| CT scan, sinuses CPT Code: 70486 | $2,112 | — | — | — |
| Blood test, complete blood count (CBC) CPT Code: 85025 | $58 | — | — | — |
| Screening mammogram (both breasts) CPT Code: 77067 | $445 | — | — | — |
| Speech therapy (language evaluation) CPT Code: 92507 | $311 | — | — | — |
| Blood test, hemoglobin CPT Code: 85018 | $21 | — | — | — |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $2,319 | — | — | — |
| Pneumococcal vaccine HCPCS Code: 90732 | $95 | — | — | — |
| Breathing treatment (nebulizer) CPT Code: 94640 | $218 | — | — | — |
| Blood test, sodium CPT Code: 84295 | $36 | — | — | — |
| Culture, bacterial CPT Code: 87070 | $94 | — | — | — |
| CT scan, head (no contrast) CPT Code: 70450 | $1,914 | — | — | — |
| Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: 90715 | $86 | — | — | — |
| CT scan, head (with contrast) CPT Code: 70460 | $2,536 | — | — | — |
| Blood test, vitamin B12 CPT Code: 82607 | $121 | — | — | — |
| Occupational therapy (therapeutic activities) CPT Code: 97530 | $128 | — | — | — |
| Ultrasound, pelvis CPT Code: 76856 | $957 | — | — | — |
| Blood test, comprehensive metabolic panel CPT Code: 80053 | $78 | — | — | — |
| Rabies immune globulin HCPCS Code: 90375 | $2,994 | — | — | — |
| Blood test, lipase CPT Code: 83690 | $51 | — | — | — |
| Ultrasound, thyroid and neck CPT Code: 76536 | $729 | — | — | — |
| MRI, brain (no contrast) CPT Code: 70551 | $3,087 | — | — | — |
| Prostate cancer screening (blood test) HCPCS Code: G0103 | $156 | — | — | — |
| Physical therapy (functional capacity test) CPT Code: 97750 | $142 | — | — | — |
| Blood test, liver function panel CPT Code: 80076 | $62 | — | — | — |
| New patient office visit (30-44 min) CPT Code: 99203 | $160 | — | — | — |
| Blood test, glucose (blood sugar) CPT Code: 82947 | $49 | — | — | — |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $3,805 | — | — | — |
| X-ray, ankle CPT Code: 73610 | $354 | — | — | — |
| X-ray, hand CPT Code: 73130 | $346 | — | — | — |
| Ultrasound, leg veins (duplex) CPT Code: 93970 | $1,338 | — | — | — |
| Blood transfusion CPT Code: 36430 | $1,040 | — | — | — |
| Blood test, clotting time (PTT) CPT Code: 85730 | $44 | — | — | — |
| X-ray, foot CPT Code: 73630 | $349 | — | — | — |
| Office visit, established patient (30-39 min) CPT Code: 99214 | $160 | — | — | — |
| Orthotic fitting and training CPT Code: 97760 | $134 | — | — | — |
| X-ray, lower back CPT Code: 72110 | $562 | — | — | — |
| Blood test, potassium CPT Code: 84132 | $34 | — | — | — |
| MMR vaccine (measles, mumps, rubella) HCPCS Code: 90707 | $103 | — | — | — |
| Physical therapy (neuromuscular re-education) CPT Code: 97112 | $126 | — | — | — |
| Blood test, basic metabolic panel CPT Code: 80048 | $64 | — | — | — |
| Diagnostic mammogram (both breasts) CPT Code: 77066 | $518 | — | — | — |
| Blood test, urea nitrogen (BUN, kidney) CPT Code: 84520 | $34 | — | — | — |
| Blood test, vitamin D CPT Code: 82306 | $114 | — | — | — |
| X-ray, chest (two views) CPT Code: 71046 | $340 | — | — | — |
| X-ray, chest (single view) CPT Code: 71045 | $254 | — | — | — |
| DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: 90700 | $75 | — | — | — |
| Ultrasound, abdomen (limited) CPT Code: 76705 | $756 | — | — | — |
| Diagnostic procedure preparation HCPCS Code: G0279 | $146 | — | — | — |
| CT scan, lower back (lumbar spine) CPT Code: 72131 | $2,508 | — | — | — |
| Occupational therapy (self-care training) CPT Code: 97535 | $128 | — | — | — |
| X-ray, shoulder CPT Code: 73030 | $361 | — | — | — |
| X-ray, hip CPT Code: 73502 | $352 | — | — | — |
| Trauma team activation HCPCS Code: G0390 | $1,792 | — | — | — |
| Electrocardiogram (EKG, tracing only) CPT Code: 93005 | $285 | — | — | — |
| Blood test, calcium CPT Code: 82310 | $34 | — | — | — |
| Ultrasound, abdomen (complete) CPT Code: 76700 | $983 | — | — | — |
| Blood test, ferritin (iron stores) CPT Code: 82728 | $110 | — | — | — |
| Hospital observation (per hour) HCPCS Code: G0378 | $73 | — | — | — |
| Physical therapy (therapeutic exercise) CPT Code: 97110 | $133 | — | — | — |
| MRI, brain (with and without contrast) CPT Code: 70553 | $4,494 | — | — | — |
| Blood test, PSA (prostate screen) CPT Code: 84153 | $90 | — | — | — |
| Culture, blood CPT Code: 87040 | $119 | — | — | — |
| Blood test, amylase CPT Code: 82150 | $79 | — | — | — |
| Blood test, creatinine (kidney) CPT Code: 82565 | $34 | — | — | — |
| Blood test, cholesterol (lipid panel) CPT Code: 80061 | $100 | — | — | — |
| X-ray, neck (cervical spine) CPT Code: 72040 | $372 | — | — | — |
| Blood test, clotting time (PT/INR) CPT Code: 85610 | $46 | — | — | — |
| Office visit, established patient (20-29 min) CPT Code: 99213 | $123 | — | — | — |
| Physical therapy (gait training) CPT Code: 97116 | $118 | — | — | — |
| Blood test, average blood sugar (A1c) CPT Code: 83036 | $69 | — | — | — |
| Sleep study (overnight, in lab) CPT Code: 95810 | $4,216 | — | — | — |
| CT scan, pelvis CPT Code: 72192 | $2,004 | — | — | — |