| Arthrocentesis (outpatient) | $824 | 0% | $824 |
| Blood Test - Complete Blood Cell Count and Automated WBC | $33 | 0% | $33 |
| Blood Test - Prostate Specific Antigen (PSA) Level | $141 | 0% | $141 |
| Lab Test - Detection test for Influenza Virus | $84 | 0% | $84 |
| MRI - Back (outpatient) | $2,828 | 0% | $2,828 |
| MRI - Knee (outpatient) | $2,115 | 0% | $2,115 |
| MRI - Shoulder, Elbow, or Wrist | $2,264 | 0% | $2,264 |
| Office Visit - Basic | $67 | 0% | $67 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 18-39 Years Old | $232 | 0% | $232 |
| Office Visit - Comprehensive Preventive Medicine Evaluation and Management, New Patient, 40-64 Years Old | $270 | 0% | $270 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 18-39 Years Old | $203 | 0% | $203 |
| Office Visit - Comprehensive Preventive Medicine Reevaluation and Management, 40-64 Years Old | $227 | 0% | $227 |
| Office Visit - Established Patient, High Complexity | $252 | 0% | $252 |
| Office Visit - Established Patient, Low Complexity | $158 | 0% | $158 |
| Office Visit - Established Patient, Moderate Complexity | $219 | 0% | $219 |
| Office Visit - New Patient, Low Complexity | $245 | 0% | $245 |
| Office Visit - New Patient, Minor | $230 | 0% | $230 |
| Physical Therapy - Electrical Stimulation Therapy | $83 | 0% | $83 |
| Physical Therapy - High Complexity Evaluation | $285 | 0% | $285 |
| Physical Therapy - Manual Therapy | $87 | 0% | $87 |
| Physical Therapy - Moderate Complexity Evaluation | $285 | 0% | $285 |
| Physical Therapy - Neuromuscular Reeducation | $89 | 0% | $89 |
| Physical Therapy - Re-Evaluation | $137 | 0% | $137 |
| Physical Therapy - Self-care or Home Management Training | $92 | 0% | $92 |
| Physical Therapy - Therapeutic Activities | $92 | 0% | $92 |
| Physical Therapy - Therapeutic Exercises | $87 | 0% | $87 |
| Physical Therapy - Ultrasound Therapy | $77 | 0% | $77 |
| Strep Test (Streptococcus, group A) | $86 | 0% | $86 |
| Urine Capacity Measurement | $285 | 0% | $285 |
| Urine Test - Automated without Microscope | $19 | 0% | $19 |
| Vaccine - Pneumococcal Conjugate for Injection into Muscle | $197 | 0% | $197 |
| Vaccine - Tetanus, Diptheria Toxoids, and Acellular Pertussis (Whooping Cough) for Injection into Muscle | $69 | 0% | $69 |
| X-Ray - Ankle (outpatient) | $400 | 0% | $400 |
| X-Ray - Foot (outpatient) | $397 | 0% | $397 |
| X-Ray - Hand | $525 | 0% | $525 |
| X-Ray - Hip | $455 | 0% | $455 |
| X-Ray - Knee (outpatient) | $480 | 0% | $480 |
| X-Ray - Middle Back, Thoracic Spine | $674 | 0% | $674 |
| X-Ray - Neck, Cervical Spine | $401 | 0% | $401 |
| X-Ray - Pelvis | $474 | 0% | $474 |
| X-Ray - Shoulder (outpatient) | $484 | 0% | $484 |
| X-Ray - Spine (outpatient) | $502 | 0% | $502 |
| X-Ray - Wrist (outpatient) | $433 | 0% | $433 |
