Diagnostic mammography $0 to  $30 copay $0 to  $30 copay 
Diagnostic colonoscopy $0 copay $0 copay 
Diagnostic radiology $180 to  $300 copay $180 to  $300 copay 
Lab services $0 to  $35 copay $0 to  $35 copay 
Diagnostic tests and procedures $0 to  $105 copay $0 to  $105 copay 
Outpatient X-rays $0 to  $90 copay $0 to  $90 copay 
Radiation therapy $30 copay or  20% of the cost $30 copay or  20% of the cost 
HEARING SERVICES