| Hospital observation (per hour) HCPCS Code: G0378 | $35 | — | — | — |
| Occupational therapy (self-care training) CPT Code: 97535 | $67 | — | — | — |
| Flu vaccine (high dose) HCPCS Code: 90656 | $35 | — | — | — |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $1,073 | — | — | — |
| Physical therapy (gait training) CPT Code: 97116 | $74 | — | — | — |
| Hip or knee replacement (inpatient stay) MS-DRG Code: 470 | $26,739 | — | — | — |
| Total knee replacement CPT Code: 27447 | $1,879 | — | — | — |
| Physical therapy (neuromuscular re-education) CPT Code: 97112 | $78 | — | — | — |
| CT scan, neck (cervical spine) CPT Code: 72125 | $723 | — | — | — |
| MRI, brain (with and without contrast) CPT Code: 70553 | $1,618 | — | — | — |
| X-ray, chest (single view) CPT Code: 71045 | $146 | — | — | — |
| Sleep study (overnight, in lab) CPT Code: 95810 | $2,448 | — | — | — |
| Blood test, basic metabolic panel CPT Code: 80048 | $32 | — | — | — |
| Flu vaccine injection HCPCS Code: G0008 | $33 | — | — | — |
| Diagnostic procedure preparation HCPCS Code: G0279 | $41 | — | — | — |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $1,694 | — | — | — |
| CT scan, head (with contrast) CPT Code: 70460 | $824 | — | — | — |
| Prosthetic fitting and training CPT Code: 97761 | $56 | — | — | — |
| CT scan, head (with and without contrast) CPT Code: 70470 | $998 | — | — | — |
| Ultrasound, abdomen (limited) CPT Code: 76705 | $308 | — | — | — |
| Blood test, magnesium CPT Code: 83735 | $42 | — | — | — |
| Physical therapy (therapeutic exercise) CPT Code: 97110 | $89 | — | — | — |
| Pneumococcal vaccine HCPCS Code: 90732 | $517 | — | — | — |
| Ultrasound, pelvis CPT Code: 76856 | $426 | — | — | — |
| Injection procedure for pain management HCPCS Code: G0260 | $1,295 | — | — | — |
| Psychiatric evaluation (first visit) CPT Code: 90791 | $302 | — | — | — |
| Blood test, clotting time (PTT) CPT Code: 85730 | $38 | — | — | — |
| Blood test, average blood sugar (A1c) CPT Code: 83036 | $43 | — | — | — |
| Urinalysis (automated, with microscopy) CPT Code: 81001 | $34 | — | — | — |
| Total hip replacement CPT Code: 27130 | $1,882 | — | — | — |
| Screening mammogram (both breasts) CPT Code: 77067 | $216 | — | — | — |
| X-ray, ankle CPT Code: 73610 | $59 | — | — | — |
| Culture, blood CPT Code: 87040 | $55 | — | — | — |
| Blood antibody screen CPT Code: 86850 | $34 | — | — | — |
| Psychological testing by technician CPT Code: 96138 | $65 | — | — | — |
| Blood test, PSA (prostate screen) CPT Code: 84153 | $59 | — | — | — |
| Psychotherapy session (45 minutes) CPT Code: 90834 | $204 | — | — | — |
| MRI, lower back (no contrast) CPT Code: 72148 | $1,149 | — | — | — |
| Blood test, clotting time (PT/INR) CPT Code: 85610 | $34 | — | — | — |
| Inguinal hernia repair CPT Code: 49505 | $847 | — | — | — |
| MRI, knee or other leg joint CPT Code: 73721 | $1,034 | — | — | — |
| Blood test, vitamin D CPT Code: 82306 | $254 | — | — | — |
| X-ray, foot CPT Code: 73630 | $57 | — | — | — |
| Electrocardiogram (ECG/EKG) CPT Code: 93000 | $50 | — | — | — |
| Physical therapy (manual therapy) CPT Code: 97140 | $89 | — | — | — |
| Neurobehavioral status check CPT Code: 96116 | $188 | — | — | — |
| Physical therapy (functional capacity test) CPT Code: 97750 | $63 | — | — | — |
| CT scan, chest (no contrast) CPT Code: 71250 | $746 | — | — | — |
| Office visit, established patient (30-39 min) CPT Code: 99214 | $150 | — | — | — |
| Ultrasound, thyroid and neck CPT Code: 76536 | $364 | — | — | — |
| CT scan, head (no contrast) CPT Code: 70450 | $735 | — | — | — |
| Family therapy session CPT Code: 90847 | $204 | — | — | — |
| X-ray, neck (cervical spine) CPT Code: 72040 | $60 | — | — | — |
| Trauma team activation HCPCS Code: G0390 | $1,036 | — | — | — |
| X-ray, lower back CPT Code: 72110 | $74 | — | — | — |
| Hepatitis C antibody test CPT Code: 86803 | $175 | — | — | — |
| Psychotherapy session (60 minutes) CPT Code: 90837 | $300 | — | — | — |
| Blood test, hemoglobin CPT Code: 85018 | $16 | — | — | — |
| MRI, brain (no contrast) CPT Code: 70551 | $1,794 | — | — | — |
| X-ray, hip CPT Code: 73502 | $81 | — | — | — |
| Blood test, amylase CPT Code: 82150 | $34 | — | — | — |
| Culture, bacterial CPT Code: 87070 | $47 | — | — | — |
| X-ray, chest (two views) CPT Code: 71046 | $147 | — | — | — |
| Blood test, lipase CPT Code: 83690 | $74 | — | — | — |
| Blood test, potassium CPT Code: 84132 | $24 | — | — | — |
| Blood test, calcium CPT Code: 82310 | $29 | — | — | — |
| Electrocardiogram (EKG, tracing only) CPT Code: 93005 | $100 | — | — | — |
| Speech therapy (group session) CPT Code: 92508 | $99 | — | — | — |
| Prostate cancer screening (blood test) HCPCS Code: G0103 | $97 | — | — | — |
| CT scan, lower back (lumbar spine) CPT Code: 72131 | $831 | — | — | — |
| Colonoscopy (diagnostic) CPT Code: 45378 | $819 | — | — | — |
| Psychological testing evaluation CPT Code: 96136 | $85 | — | — | — |
| CT scan, sinuses CPT Code: 70486 | $814 | — | — | — |
| Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: 90715 | $41 | — | — | — |
| Blood test, liver function panel CPT Code: 80076 | $55 | — | — | — |
| Blood test, cholesterol (lipid panel) CPT Code: 80061 | $46 | — | — | — |
| Blood test, vitamin B12 CPT Code: 82607 | $80 | — | — | — |
| Blood test, ferritin (iron stores) CPT Code: 82728 | $80 | — | — | — |
| Speech therapy (language evaluation) CPT Code: 92507 | $112 | — | — | — |
| Pneumonia vaccine injection HCPCS Code: G0009 | $15 | — | — | — |
| Colonoscopy with biopsy CPT Code: 45380 | $1,240 | — | — | — |
| X-ray, shoulder CPT Code: 73030 | $57 | — | — | — |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $2,450 | — | — | — |
| Breathing treatment (nebulizer) CPT Code: 94640 | $163 | — | — | — |
| Diagnostic mammogram (both breasts) CPT Code: 77066 | $411 | — | — | — |
| Blood test, sodium CPT Code: 84295 | $24 | — | — | — |
| Blood test, creatinine (kidney) CPT Code: 82565 | $19 | — | — | — |
| X-ray, hand CPT Code: 73130 | $52 | — | — | — |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $2,352 | — | — | — |
| New patient office visit (30-44 min) CPT Code: 99203 | $177 | — | — | — |
| Blood test, urea nitrogen (BUN, kidney) CPT Code: 84520 | $26 | — | — | — |
| Ultrasound, leg veins (duplex) CPT Code: 93970 | $666 | — | — | — |
| Blood test, glucose (blood sugar) CPT Code: 82947 | $18 | — | — | — |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $1,305 | — | — | — |
| Blood test, thyroid (TSH) CPT Code: 84443 | $21 | — | — | — |
| CT scan, pelvis CPT Code: 72192 | $776 | — | — | — |
| Upper endoscopy with biopsy CPT Code: 43239 | $883 | — | — | — |
| Office visit, established patient (20-29 min) CPT Code: 99213 | $108 | — | — | — |
| X-ray, pelvis CPT Code: 72170 | $47 | — | — | — |
| Occupational therapy (therapeutic activities) CPT Code: 97530 | $77 | — | — | — |
| Blood transfusion CPT Code: 36430 | $251 | — | — | — |
| Orthotic fitting and training CPT Code: 97760 | $71 | — | — | — |
| Bunion correction surgery CPT Code: 28296 | $749 | — | — | — |
| Breast lump removal CPT Code: 19120 | $998 | — | — | — |
| Cataract surgery with lens implant CPT Code: 66984 | $3,091 | — | — | — |
| Ultrasound, abdomen (complete) CPT Code: 76700 | $460 | — | — | — |
| Group therapy session CPT Code: 90853 | $55 | — | — | — |
| Blood test, comprehensive metabolic panel CPT Code: 80053 | $23 | — | — | — |
| Blood test, complete blood count (CBC) CPT Code: 85025 | $28 | — | — | — |