The following is a list of the services, procedure codes that were completed by the Mayo Clinic of Jacksonville during my annual Executive Physical program:

 Executive Annual Physical program - web link: http://www.mayoclinic.org/executive-health
Note: The "allowed charge" is based on my Blue Cross Blue Shield PPO plan from my place of work.  You would have to check with the Mayo's website to see if they accept your insurance and look at your insurance plan document to see what services would be covered.
 

       Procedure Code - Description
 

Mayo Charge
 

BCBS Allowed Charge
 
Blood work:

84295 - Blood/Sodium, Serum
84132 - Blood/Potassium
83540 - Blood/Iron Total
86141 - C-Reactive Protein High Sensit
84153 - PSA Screening
81001 - Urinalysis
80061 - Lipid Panel
84075 - Blood/Alkaline Phospatase
84450 - Blood/AST (GOT) Serum
84550 - Blood/Uric Acid
82565 - Blood/Creatinine, Plasma
82310 - Blood/Calcuim Total Serum
82947 - Blood/Glucose Determine
84155 - Blood/Protein Total Serum
84443 - Blood/High Sensitive Thyrotropin
83695 - Blood/Lipoprotein A Serum
83550 - Blood/Iron Binding Capacity
85025 - Blood/CBC w/ Differential
36415 - Blood/Venipuncture

Other:

93000 - EKG Electrocardiogram
93015 - Cardiac Stress Test
99199 - Body Fat Analysis
71020 - Chest X-ray
99205 - Physical with Doctor
 


 
$34.00  
$33.00  
$51.00  
$72.00  
$138.00  
$34.00  
$122.00  
$33.00  
$37.00  
$37.00  
$31.00  
$37.00  
$28.00  
$32.00  
$139.00  
$92.00  
$66.00  
$57.00  
$29.00  



$128.00
$658.00
$139.00
$161.00
$491.00

=========

$2,679.00   
 



$9.00  
$6.74  
$9.50  
$28.00  
$26.99  
$4.65  
$19.66  
$7.59  
$7.58  
$6.63  
$7.52  
$7.56  
$5.75  
$5.38  
$24.64  
$18.99  
$12.83  
$11.40  
$0.00  



$128.00  
$273.91  
$0.00  
$87.04  
$490.98  

=========

$1,200.34   

Note: 

Items in the BCBS Allowed Charge with the GREEN color means they were originally processed successfully with the diagnostic code of V70.0 (annual exam).  These items are covered 100% by BCBS's "Preventative Care" program under the PPO plan I have.

Items in the BCBS Allowed Charge with the BLUE color means they were originally rejected/denied with the annual exam diagnostic code of V70.0, Mayo had to resubmit them with an additional diagnostic code of V72.62 ("Laboratory examination ordered as part of a routine general medical examination"), and then they processed successfully.

Items in the BCBS Allowed Charge with the RED color means they were covered at 100% due to plan contract with Mayo/BCBS, this was no charge to me.

Items in the BCBS Allowed Charge with the PURPLE color means they were submitted to BCBS, but no EOB ever came through, Mayo had submitted them, but something in the process got lost, so Mayo ended up just writing that $139.00 off the bill rather than trying to figure out what the issue was with BCBS.