| Arthrocentesis (outpatient) | $484 | 0% | $484 |
| Bone Density Scan (outpatient) | $678 | 0% | $678 |
| MRI - Back (outpatient) | $2,423 | 0% | $2,423 |
| MRI - Knee (outpatient) | $2,157 | 0% | $2,157 |
| MRI - Shoulder, Elbow, or Wrist | $2,157 | 0% | $2,157 |
| Office Visit - Basic | $113 | 0% | $113 |
| Office Visit - Established Patient, High Complexity | $343 | 0% | $343 |
| Office Visit - Established Patient, Low Complexity | $155 | 0% | $155 |
| Office Visit - Established Patient, Moderate Complexity | $230 | 0% | $230 |
| Office Visit - New Patient, Low Complexity | $255 | 0% | $255 |
| Office Visit - New Patient, Moderate Complexity | $360 | 0% | $360 |
| Physical Therapy - Low Complexity Evaluation | $156 | 0% | $156 |
| Physical Therapy - Manual Therapy | $72 | 0% | $72 |
| Physical Therapy - Therapeutic Exercises | $96 | 0% | $96 |
| X-Ray - Ankle (outpatient) | $302 | 0% | $302 |
| X-Ray - Foot (outpatient) | $290 | 0% | $290 |
| X-Ray - Hand | $427 | 0% | $427 |
| X-Ray - Hip | $584 | 0% | $584 |
| X-Ray - Knee (outpatient) | $454 | 0% | $454 |
| X-Ray - Neck, Cervical Spine | $352 | 0% | $352 |
| X-Ray - Pelvis | $386 | 0% | $386 |
| X-Ray - Shoulder (outpatient) | $435 | 0% | $435 |
| X-Ray - Spine (outpatient) | $492 | 0% | $492 |
| X-Ray - Wrist (outpatient) | $397 | 0% | $397 |
