What Are My Benefits? Property of Bind Benefits, Inc., d/b/a Surest. All rights reserved © 2026. 23 • Routine diagnostic services, including diagnostic lab, x-ray, and ultrasound are included in the facility service or surgery copayment. When the routine diagnostic service is prescribed by a doctor and received on a different date of service and location, the service is $0 copayment. • Services for illness and injury-related diagnostic purposes, received on an outpatient basis at a hospital, alternate facility, or in a Physician’s office include: − Non-routine diagnostic testing including, but not limited to: ◦ Angiography (Arteriography). ◦ Cardiac Event Monitoring. ◦ Coronary Calcium Score (Heart Scan). ◦ Cystometrogram (CMG). ◦ Diagnostic Hearing Exams and Testing. ◦ Echocardiogram Exercise Stress Test. ◦ EKG Exercise Stress Test. ◦ Electroencephalogram (EEG). ◦ Electromyography (EMG) and Nerve Conduction Studies (NCS). ◦ Gastrointestinal Motility Testing. ◦ Genetic Testing. ◦ Home Sleep Test & Unattended Sleep Study. ◦ Attended Sleep Study (Polysomnography). ◦ Non-cardiac Angiography, Arthrography, and Myelography. ◦ Pulmonary Function Tests. ◦ Tilt Table Testing. ◦ Transthoracic Echocardiogram (TTE). − Routine diagnostic testing such as: ◦ Diagnostic labs, pathology tests, and interpretation charges, such as blood tests, analysis of tissues, or liquids from the body. ◦ Diagnostic ultrasounds and X-rays, such as fluoroscopic tests and interpretation. • If more than one type of imaging occurs, such as an x-ray and ultrasound, on the same date of service, more than one copayment may apply. • If more than one type of diagnostic testing occurs, such as an EKG exercise stress test and an electroencephalogram (EEG), on the same date of service, more than one copayment may apply. • The following categories of Genetic Testing services are covered: − Genetic tests for cancer susceptibility. − Genetic tests for hereditary diseases. − Unspecified molecular pathology. − Fetal aneuploidy testing. • Select Laboratory services and Diagnostic Testing may require Prior Authorization and Medical Necessity review.