| Flu vaccine (high dose) HCPCS Code: 90656 | $46 | — | $24 | — |
| Rabies immune globulin HCPCS Code: 90375 | $766 | — | $462 | — |
| X-ray, chest (two views) CPT Code: 71046 | $327 | — | $102 | unverified |
| Screening mammogram (both breasts) CPT Code: 77067 | $296 | — | $131 | unverified |
| Occupational therapy (self-care training) CPT Code: 97535 | $80 | — | $52 | — |
| Urinalysis (automated, with microscopy) CPT Code: 81001 | $75 | — | $5 | unverified |
| X-ray, hip CPT Code: 73502 | $361 | — | $106 | unverified |
| X-ray, pelvis CPT Code: 72170 | $347 | — | $114 | unverified |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $1,383 | — | $806 | unverified |
| MMR vaccine (measles, mumps, rubella) HCPCS Code: 90707 | $196 | — | $115 | — |
| Digestive disorders treatment (inpatient stay) MS-DRG Code: 392 | $12,922 | — | $9,622 | — |
| X-ray, ankle CPT Code: 73610 | $432 | — | $117 | unverified |
| Blood test, amylase CPT Code: 82150 | $113 | — | $9 | unverified |
| Blood test, vitamin D CPT Code: 82306 | $122 | — | $53 | unverified |
| CT scan, lower back (lumbar spine) CPT Code: 72131 | $2,847 | — | $294 | unverified |
| Speech therapy (group session) CPT Code: 92508 | $92 | — | $32 | unverified |
| Ultrasound, pelvis CPT Code: 76856 | $1,008 | — | $165 | unverified |
| Group therapy session CPT Code: 90853 | $180 | — | $106 | — |
| CT scan, head (no contrast) CPT Code: 70450 | $2,469 | — | $280 | unverified |
| X-ray, shoulder CPT Code: 73030 | $343 | — | $108 | unverified |
| MRI, lower back (no contrast) CPT Code: 72148 | $1,960 | — | $517 | unverified |
| Family therapy session CPT Code: 90847 | $252 | — | $211 | unverified |
| Ultrasound, thyroid and neck CPT Code: 76536 | $551 | — | $171 | unverified |
| Blood test, complete blood count (CBC) CPT Code: 85025 | $58 | — | $10 | unverified |
| Office visit, established patient (30-39 min) CPT Code: 99214 | $286 | — | $125 | unverified |
| Blood test, basic metabolic panel CPT Code: 80048 | $123 | — | $12 | unverified |
| Blood test, comprehensive metabolic panel CPT Code: 80053 | $238 | — | $14 | unverified |
| CT scan, chest (no contrast) CPT Code: 71250 | $2,254 | — | $280 | unverified |
| MRI, knee or other leg joint CPT Code: 73721 | $2,620 | — | $632 | unverified |
| Blood test, potassium CPT Code: 84132 | $19 | — | $6 | unverified |
| Office visit, established patient (20-29 min) CPT Code: 99213 | $215 | — | $83 | unverified |
| Blood test, PSA (prostate screen) CPT Code: 84153 | $188 | — | $28 | unverified |
| Blood test, liver function panel CPT Code: 80076 | $130 | — | $10 | unverified |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $5,344 | — | $493 | unverified |
| Blood test, calcium CPT Code: 82310 | $22 | — | $6 | unverified |
| Flu vaccine injection HCPCS Code: G0008 | $32 | — | $44 | — |
| Psychotherapy session (45 minutes) CPT Code: 90834 | $246 | — | $204 | unverified |
| MRI, brain (no contrast) CPT Code: 70551 | $1,600 | — | $526 | unverified |
| Electrical stimulation therapy HCPCS Code: G0283 | $97 | — | $23 | unverified |
| Diagnostic mammogram (both breasts) CPT Code: 77066 | $413 | — | $170 | unverified |
| Hospital observation (per hour) HCPCS Code: G0378 | $90 | — | $77 | — |
| Ultrasound, abdomen (limited) CPT Code: 76705 | $754 | — | $144 | unverified |
| Blood test, average blood sugar (A1c) CPT Code: 83036 | $104 | — | $12 | unverified |
| Sleep study (overnight, in lab) CPT Code: 95810 | $2,155 | — | $1,116 | — |
| Speech therapy (language evaluation) CPT Code: 92507 | $119 | — | $92 | — |
| Orthotic fitting and training CPT Code: 97760 | $64 | — | $64 | — |
| Physical therapy (gait training) CPT Code: 97116 | $108 | — | $48 | unverified |
| Pneumococcal vaccine HCPCS Code: 90732 | $277 | — | $143 | — |
| CT scan, sinuses CPT Code: 70486 | $1,136 | — | $298 | unverified |
| Blood test, glucose (blood sugar) CPT Code: 82947 | $108 | — | $6 | unverified |
| Pneumonia vaccine injection HCPCS Code: G0009 | $33 | — | $49 | — |
| Prostate cancer screening (blood test) HCPCS Code: G0103 | $95 | — | $26 | unverified |
| Blood test, sodium CPT Code: 84295 | $21 | — | $6 | unverified |
| Blood test, creatinine (kidney) CPT Code: 82565 | $19 | — | $7 | — |
| Prosthetic fitting and training CPT Code: 97761 | $102 | — | $58 | — |
| Blood antibody screen CPT Code: 86850 | $105 | — | $34 | unverified |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $5,308 | — | $613 | unverified |
| Physical therapy (manual therapy) CPT Code: 97140 | $104 | — | $45 | unverified |
| Blood test, clotting time (PT/INR) CPT Code: 85610 | $43 | — | $6 | unverified |
| DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: 90700 | $141 | — | $39 | unverified |
| X-ray, lower back CPT Code: 72110 | $620 | — | $142 | unverified |
| MRI, brain (with and without contrast) CPT Code: 70553 | $3,533 | — | $707 | unverified |
| Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: 90715 | $127 | — | $59 | — |
| Electrocardiogram (EKG, tracing only) CPT Code: 93005 | $268 | — | $77 | unverified |
| Hepatitis B vaccine HCPCS Code: 90744 | $51 | — | $43 | — |
| Blood test, lipase CPT Code: 83690 | $94 | — | $10 | unverified |
| Blood test, urea nitrogen (BUN, kidney) CPT Code: 84520 | $105 | — | $5 | unverified |
| X-ray, hand CPT Code: 73130 | $375 | — | $113 | unverified |
| Culture, bacterial CPT Code: 87070 | $104 | — | $11 | unverified |
| Blood test, thyroid (TSH) CPT Code: 84443 | $50 | — | $25 | — |
| X-ray, neck (cervical spine) CPT Code: 72040 | $347 | — | $103 | unverified |
| Ultrasound, leg veins (duplex) CPT Code: 93970 | $820 | — | $318 | unverified |
| Ultrasound, abdomen (complete) CPT Code: 76700 | $943 | — | $173 | unverified |
| X-ray, chest (single view) CPT Code: 71045 | $282 | — | $98 | unverified |
| New patient office visit (30-44 min) CPT Code: 99203 | $399 | — | $105 | unverified |
| Blood test, ferritin (iron stores) CPT Code: 82728 | $98 | — | $19 | unverified |
| CT scan, pelvis CPT Code: 72192 | $2,260 | — | $286 | unverified |
| X-ray, foot CPT Code: 73630 | $375 | — | $112 | unverified |
| Blood test, vitamin B12 CPT Code: 82607 | $145 | — | $22 | unverified |
| Blood test, magnesium CPT Code: 83735 | $88 | — | $9 | unverified |
| Blood test, clotting time (PTT) CPT Code: 85730 | $58 | — | $8 | unverified |
| CT scan, neck (cervical spine) CPT Code: 72125 | $3,308 | — | $285 | unverified |
| Hepatitis C antibody test CPT Code: 86803 | $92 | — | $21 | unverified |
| Blood test, cholesterol (lipid panel) CPT Code: 80061 | $190 | — | $19 | unverified |
| Breathing treatment (nebulizer) CPT Code: 94640 | $80 | — | $120 | — |
| Occupational therapy (therapeutic activities) CPT Code: 97530 | $83 | — | $55 | — |
| Hepatitis B immune globulin HCPCS Code: 90371 | $212 | — | $188 | — |
| Typhoid vaccine HCPCS Code: 90675 | $996 | — | $460 | unverified |
| Blood test, hemoglobin CPT Code: 85018 | $60 | — | $4 | unverified |
| Hip or knee replacement (inpatient stay) MS-DRG Code: 470 | $41,241 | — | $21,399 | — |
| Culture, blood CPT Code: 87040 | $172 | — | $14 | unverified |
| Sepsis treatment (inpatient stay) MS-DRG Code: 871 | $21,507 | — | $20,613 | — |
| CT scan, head (with and without contrast) CPT Code: 70470 | $2,840 | — | $410 | unverified |
| Physical therapy (therapeutic exercise) CPT Code: 97110 | $98 | — | $48 | unverified |
| Psychotherapy session (60 minutes) CPT Code: 90837 | $331 | — | $201 | unverified |
| Physical therapy (neuromuscular re-education) CPT Code: 97112 | $100 | — | $53 | unverified |
| Injection procedure for pain management HCPCS Code: G0260 | $847 | — | $786 | — |
| CT scan, head (with contrast) CPT Code: 70460 | $2,612 | — | $402 | unverified |
| Blood transfusion CPT Code: 36430 | $2,043 | — | $451 | unverified |