| Physical therapy (functional capacity test) CPT Code: 97750 | $22 | — | — | — |
| Blood test, ferritin (iron stores) CPT Code: 82728 | $10 | — | — | — |
| Breathing treatment (nebulizer) CPT Code: 94640 | $64 | — | — | — |
| X-ray, pelvis CPT Code: 72170 | $30 | — | — | — |
| Diagnostic mammogram (both breasts) CPT Code: 77066 | $130 | — | — | — |
| X-ray, foot CPT Code: 73630 | $130 | — | — | — |
| Prostate cancer screening (blood test) HCPCS Code: G0103 | $14 | — | — | — |
| Blood transfusion CPT Code: 36430 | $64 | — | — | — |
| Blood test, vitamin B12 CPT Code: 82607 | $8 | — | — | — |
| Blood test, amylase CPT Code: 82150 | $31 | — | — | — |
| Culture, bacterial CPT Code: 87070 | $15 | — | — | — |
| Hepatitis B vaccine HCPCS Code: 90744 | $59 | — | — | — |
| Orthotic fitting and training CPT Code: 97760 | $17 | — | — | — |
| X-ray, chest (two views) CPT Code: 71046 | $66 | — | — | — |
| Speech therapy (language evaluation) CPT Code: 92507 | $45 | — | — | — |
| CT scan, pelvis CPT Code: 72192 | $163 | — | — | — |
| CT scan, head (with contrast) CPT Code: 70460 | $232 | — | — | — |
| DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: 90700 | $57 | — | — | — |
| CT scan, lower back (lumbar spine) CPT Code: 72131 | $431 | — | — | — |
| Occupational therapy (self-care training) CPT Code: 97535 | $15 | — | — | — |
| X-ray, chest (single view) CPT Code: 71045 | $60 | — | — | — |
| Ultrasound, thyroid and neck CPT Code: 76536 | $291 | — | — | — |
| Colonoscopy with biopsy CPT Code: 45380 | $682 | — | — | — |
| Drug screening test HCPCS Code: G0480 | $61 | — | — | — |
| Blood test, cholesterol (lipid panel) CPT Code: 80061 | $16 | — | — | — |
| Hepatitis C antibody test CPT Code: 86803 | $11 | — | — | — |
| Occupational therapy (therapeutic activities) CPT Code: 97530 | $25 | — | — | — |
| Upper endoscopy with biopsy CPT Code: 43239 | $520 | — | — | — |
| Ultrasound, abdomen (limited) CPT Code: 76705 | $259 | — | — | — |
| Screening mammogram (both breasts) CPT Code: 77067 | $87 | — | — | — |
| Blood test, comprehensive metabolic panel CPT Code: 80053 | $28 | — | — | — |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $564 | — | — | — |
| Urinalysis (automated, with microscopy) CPT Code: 81001 | $12 | — | — | — |
| Ultrasound, leg veins (duplex) CPT Code: 93970 | $292 | — | — | — |
| Ultrasound, pelvis CPT Code: 76856 | $331 | — | — | — |
| Rabies immune globulin HCPCS Code: 90375 | $798 | — | — | — |
| X-ray, hip CPT Code: 73502 | $31 | — | — | — |
| Blood test, calcium CPT Code: 82310 | $5 | — | — | — |
| MRI, knee or other leg joint CPT Code: 73721 | $828 | — | — | — |
| X-ray, hand CPT Code: 73130 | $110 | — | — | — |
| CT scan, sinuses CPT Code: 70486 | $170 | — | — | — |
| Injection procedure for pain management HCPCS Code: G0260 | $439 | — | — | — |
| MRI, brain (no contrast) CPT Code: 70551 | $634 | — | — | — |
| Electrocardiogram (EKG, tracing only) CPT Code: 93005 | $57 | — | — | — |
| Blood test, magnesium CPT Code: 83735 | $26 | — | — | — |
| Blood test, basic metabolic panel CPT Code: 80048 | $19 | — | — | — |
| Culture, blood CPT Code: 87040 | $16 | — | — | — |
| Blood test, urea nitrogen (BUN, kidney) CPT Code: 84520 | $5 | — | — | — |
| CT scan, chest (no contrast) CPT Code: 71250 | $543 | — | — | — |
| Flu vaccine injection HCPCS Code: G0008 | $21 | — | — | — |
| Colorectal cancer screening HCPCS Code: G0010 | $11 | — | — | — |
| Sleep study (overnight, in lab) CPT Code: 95810 | $865 | — | — | — |
| Trauma team activation HCPCS Code: G0390 | $1,661 | — | — | — |
| MMR vaccine (measles, mumps, rubella) HCPCS Code: 90707 | $91 | — | — | — |
| CT scan, head (no contrast) CPT Code: 70450 | $242 | — | — | — |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $102 | — | — | — |
| X-ray, ankle CPT Code: 73610 | $127 | — | — | — |
| Blood test, average blood sugar (A1c) CPT Code: 83036 | $7 | — | — | — |
| Blood test, sodium CPT Code: 84295 | $10 | — | — | — |
| Colonoscopy (diagnostic) CPT Code: 45378 | $620 | — | — | — |
| Varicella (chickenpox) vaccine HCPCS Code: 90716 | $182 | — | — | — |
| X-ray, lower back CPT Code: 72110 | $138 | — | — | — |
| CT scan, head (with and without contrast) CPT Code: 70470 | $292 | — | — | — |
| Blood antibody screen CPT Code: 86850 | $31 | — | — | — |
| Blood test, lipase CPT Code: 83690 | $29 | — | — | — |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $893 | — | — | — |
| Blood test, clotting time (PTT) CPT Code: 85730 | $11 | — | — | — |
| X-ray, neck (cervical spine) CPT Code: 72040 | $117 | — | — | — |
| Prosthetic fitting and training CPT Code: 97761 | $15 | — | — | — |
| Physical therapy (manual therapy) CPT Code: 97140 | $21 | — | — | — |
| Blood test, creatinine (kidney) CPT Code: 82565 | $29 | — | — | — |
| CT scan, neck (cervical spine) CPT Code: 72125 | $340 | — | — | — |
| Physical therapy (neuromuscular re-education) CPT Code: 97112 | $17 | — | — | — |
| Blood test, thyroid (TSH) CPT Code: 84443 | $35 | — | — | — |
| Pneumonia vaccine injection HCPCS Code: G0009 | $21 | — | — | — |
| Blood test, glucose (blood sugar) CPT Code: 82947 | $5 | — | — | — |
| X-ray, shoulder CPT Code: 73030 | $109 | — | — | — |
| Blood test, PSA (prostate screen) CPT Code: 84153 | $20 | — | — | — |
| MRI, brain (with and without contrast) CPT Code: 70553 | $839 | — | — | — |
| Blood test, hemoglobin CPT Code: 85018 | $6 | — | — | — |
| Blood test, clotting time (PT/INR) CPT Code: 85610 | $5 | — | — | — |
| Blood test, vitamin D CPT Code: 82306 | $12 | — | — | — |
| Hospital observation (per hour) HCPCS Code: G0378 | $5 | — | — | — |
| MRI, lower back (no contrast) CPT Code: 72148 | $767 | — | — | — |
| Ultrasound, abdomen (complete) CPT Code: 76700 | $274 | — | — | — |
| Physical therapy (therapeutic exercise) CPT Code: 97110 | $22 | — | — | — |
| Blood test, liver function panel CPT Code: 80076 | $19 | — | — | — |
| Pneumococcal vaccine HCPCS Code: 90732 | $111 | — | — | — |
| Blood test, potassium CPT Code: 84132 | $7 | — | — | — |
| Electrical stimulation therapy HCPCS Code: G0283 | $9 | — | — | — |
| Physical therapy (gait training) CPT Code: 97116 | $26 | — | — | — |
| Blood test, complete blood count (CBC) CPT Code: 85025 | $13 | — | — | — |