| X-ray, shoulder CPT Code: 73030 | $489 | — | — | — |
| MRI, knee or other leg joint CPT Code: 73721 | $3,869 | — | — | — |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $5,468 | — | — | — |
| C-section delivery (full package) CPT Code: 59510 | $5,098 | — | — | — |
| New patient office visit (30-44 min) CPT Code: 99203 | $246 | — | — | — |
| MRI, brain (with and without contrast) CPT Code: 70553 | $5,817 | — | — | — |
| Breast lump removal CPT Code: 19120 | $823 | — | — | — |
| Blood test, thyroid (TSH) CPT Code: 84443 | $196 | — | — | — |
| Flu vaccine injection HCPCS Code: G0008 | $147 | — | — | — |
| Physical therapy (manual therapy) CPT Code: 97140 | $152 | — | — | — |
| X-ray, pelvis CPT Code: 72170 | $517 | — | — | — |
| Ultrasound, abdomen (complete) CPT Code: 76700 | $1,143 | — | — | — |
| Blood antibody screen CPT Code: 86850 | $162 | — | — | — |
| CT scan, chest (no contrast) CPT Code: 71250 | $3,886 | — | — | — |
| Typhoid vaccine HCPCS Code: 90675 | $755 | — | — | — |
| Blood test, urea nitrogen (BUN, kidney) CPT Code: 84520 | $52 | — | — | — |
| Inguinal hernia repair CPT Code: 49505 | $1,024 | — | — | — |
| Blood test, average blood sugar (A1c) CPT Code: 83036 | $79 | — | — | — |
| DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: 90700 | $72 | — | — | — |
| Culture, blood CPT Code: 87040 | $191 | — | — | — |
| Ultrasound, pelvis CPT Code: 76856 | $1,036 | — | — | — |
| Culture, bacterial CPT Code: 87070 | $162 | — | — | — |
| CT scan, sinuses CPT Code: 70486 | $2,620 | — | — | — |
| X-ray, neck (cervical spine) CPT Code: 72040 | $474 | — | — | — |
| Physical therapy (gait training) CPT Code: 97116 | $150 | — | — | — |
| Physical therapy (therapeutic exercise) CPT Code: 97110 | $160 | — | — | — |
| Blood test, clotting time (PT/INR) CPT Code: 85610 | $43 | — | — | — |
| Blood transfusion CPT Code: 36430 | $1,260 | — | — | — |
| Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: 90715 | $148 | — | — | — |
| Blood test, liver function panel CPT Code: 80076 | $197 | — | — | — |
| Office visit, established patient (20-29 min) CPT Code: 99213 | $123 | — | — | — |
| Blood test, sodium CPT Code: 84295 | $41 | — | — | — |
| Diagnostic mammogram (both breasts) CPT Code: 77066 | $537 | — | — | — |
| Ultrasound, leg veins (duplex) CPT Code: 93970 | $1,935 | — | — | — |
| Screening mammogram (both breasts) CPT Code: 77067 | $447 | — | — | — |
| Varicella (chickenpox) vaccine HCPCS Code: 90716 | $376 | — | — | — |
| Speech therapy (language evaluation) CPT Code: 92507 | $442 | — | — | — |
| MMR vaccine (measles, mumps, rubella) HCPCS Code: 90707 | $205 | — | — | — |
| X-ray, hip CPT Code: 73502 | $415 | — | — | — |
| X-ray, hand CPT Code: 73130 | $682 | — | — | — |
| Blood test, clotting time (PTT) CPT Code: 85730 | $65 | — | — | — |
| Colorectal cancer screening HCPCS Code: G0010 | $142 | — | — | — |
| Blood test, hemoglobin CPT Code: 85018 | $52 | — | — | — |
| Blood test, calcium CPT Code: 82310 | $52 | — | — | — |
| Blood test, cholesterol (lipid panel) CPT Code: 80061 | $120 | — | — | — |
| Occupational therapy (self-care training) CPT Code: 97535 | $452 | — | — | — |
| Pneumonia vaccine injection HCPCS Code: G0009 | $147 | — | — | — |
| X-ray, ankle CPT Code: 73610 | $619 | — | — | — |
| Blood test, basic metabolic panel CPT Code: 80048 | $127 | — | — | — |
| X-ray, chest (single view) CPT Code: 71045 | $376 | — | — | — |
| MRI, lower back (no contrast) CPT Code: 72148 | $5,421 | — | — | — |
| Upper endoscopy with biopsy CPT Code: 43239 | $1,622 | — | — | — |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $6,471 | — | — | — |
| Vaginal delivery (full package) CPT Code: 59400 | $4,635 | — | — | — |
| X-ray, chest (two views) CPT Code: 71046 | $477 | — | — | — |
| Blood test, amylase CPT Code: 82150 | $83 | — | — | — |
| Ultrasound, thyroid and neck CPT Code: 76536 | $963 | — | — | — |
| Ultrasound, abdomen (limited) CPT Code: 76705 | $582 | — | — | — |
| Blood test, creatinine (kidney) CPT Code: 82565 | $89 | — | — | — |
| Blood test, vitamin D CPT Code: 82306 | $107 | — | — | — |
| Blood test, potassium CPT Code: 84132 | $86 | — | — | — |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $1,091 | — | — | — |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $3,048 | — | — | — |
| Physical therapy (neuromuscular re-education) CPT Code: 97112 | $152 | — | — | — |
| Colonoscopy with biopsy CPT Code: 45380 | $1,659 | — | — | — |
| Blood test, PSA (prostate screen) CPT Code: 84153 | $161 | — | — | — |
| X-ray, foot CPT Code: 73630 | $678 | — | — | — |
| Diagnostic procedure preparation HCPCS Code: G0279 | $72 | — | — | — |
| Blood test, complete blood count (CBC) CPT Code: 85025 | $122 | — | — | — |
| CT scan, head (with contrast) CPT Code: 70460 | $3,708 | — | — | — |
| Blood test, magnesium CPT Code: 83735 | $86 | — | — | — |
| CT scan, pelvis CPT Code: 72192 | $4,706 | — | — | — |
| Blood test, lipase CPT Code: 83690 | $115 | — | — | — |
| Hepatitis C antibody test CPT Code: 86803 | $149 | — | — | — |
| Rabies immune globulin HCPCS Code: 90375 | $652 | — | — | — |
| CT scan, head (with and without contrast) CPT Code: 70470 | $4,262 | — | — | — |
| Hepatitis B vaccine HCPCS Code: 90744 | $65 | — | — | — |
| Blood test, ferritin (iron stores) CPT Code: 82728 | $234 | — | — | — |
| CT scan, head (no contrast) CPT Code: 70450 | $3,371 | — | — | — |
| Trauma team activation HCPCS Code: G0390 | $2,060 | — | — | — |
| X-ray, lower back CPT Code: 72110 | $626 | — | — | — |
| Office visit, established patient (30-39 min) CPT Code: 99214 | $328 | — | — | — |
| Orthotic fitting and training CPT Code: 97760 | $150 | — | — | — |
| Electrocardiogram (EKG, tracing only) CPT Code: 93005 | $378 | — | — | — |
| Blood test, glucose (blood sugar) CPT Code: 82947 | $80 | — | — | — |
| Blood test, comprehensive metabolic panel CPT Code: 80053 | $269 | — | — | — |
| Blood test, vitamin B12 CPT Code: 82607 | $37 | — | — | — |
| Urinalysis (automated, with microscopy) CPT Code: 81001 | $96 | — | — | — |
| CT scan, lower back (lumbar spine) CPT Code: 72131 | $3,902 | — | — | — |
| CT scan, neck (cervical spine) CPT Code: 72125 | $3,746 | — | — | — |
| Breathing treatment (nebulizer) CPT Code: 94640 | $271 | — | — | — |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $5,517 | — | — | — |
| Injection procedure for pain management HCPCS Code: G0260 | $1,122 | — | — | — |
| MRI, brain (no contrast) CPT Code: 70551 | $4,598 | — | — | — |
| Colonoscopy (diagnostic) CPT Code: 45378 | $1,643 | — | — | — |
| Flu vaccine (high dose) HCPCS Code: 90656 | $20 | — | — | — |
| Occupational therapy (therapeutic activities) CPT Code: 97530 | $150 | — | — | — |