| Arthrocentesis (outpatient) | $549 | 0% | $549 |
| Arthroscopic Shoulder Surgery | $82,900 | 0% | $82,900 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $33 | 0% | $33 |
| MRI - Back (outpatient) | $3,419 | 0% | $3,419 |
| MRI - Knee (outpatient) | $3,231 | 0% | $3,231 |
| MRI - Shoulder, Elbow, or Wrist | $3,213 | 0% | $3,213 |
| Office Visit - Basic | $129 | 0% | $129 |
| Office Visit - Established Patient, Low Complexity | $167 | 0% | $167 |
| Office Visit - Established Patient, Moderate Complexity | $242 | 0% | $242 |
| Office Visit - New Patient, Low Complexity | $274 | 0% | $274 |
| Office Visit - New Patient, Minor | $210 | 0% | $210 |
| Office Visit - New Patient, Moderate Complexity | $390 | 0% | $390 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $79 | 0% | $79 |
| Physical Therapy - Application of Hot or Cold Pack | $56 | 0% | $56 |
| Physical Therapy - Application of Mechanical Traction | $63 | 0% | $63 |
| Physical Therapy - Electrical Stimulation Therapy | $62 | 0% | $62 |
| Physical Therapy - High Complexity Evaluation | $311 | 0% | $311 |
| Physical Therapy - Low Complexity Evaluation | $311 | 0% | $311 |
| Physical Therapy - Manual Therapy | $80 | 0% | $80 |
| Physical Therapy - Moderate Complexity Evaluation | $311 | 0% | $311 |
| Physical Therapy - Neuromuscular Reeducation | $101 | 0% | $101 |
| Physical Therapy - Re-Evaluation | $174 | 0% | $174 |
| Physical Therapy - Self-care or Home Management Training | $110 | 0% | $110 |
| Physical Therapy - Therapeutic Activities | $116 | 0% | $116 |
| Physical Therapy - Therapeutic Exercises | $104 | 0% | $104 |
| Physical Therapy - Ultrasound Therapy | $83 | 0% | $83 |
| X-Ray - Ankle (outpatient) | $449 | 0% | $449 |
| X-Ray - Foot (outpatient) | $413 | 0% | $413 |
| X-Ray - Hand | $462 | 0% | $462 |
| X-Ray - Hip | $490 | 0% | $490 |
| X-Ray - Knee (outpatient) | $648 | 0% | $648 |
| X-Ray - Middle Back, Thoracic Spine | $485 | 0% | $485 |
| X-Ray - Neck, Cervical Spine | $450 | 0% | $450 |
| X-Ray - Shoulder (outpatient) | $485 | 0% | $485 |
| X-Ray - Spine (outpatient) | $456 | 0% | $456 |
| X-Ray - Wrist (outpatient) | $437 | 0% | $437 |
