| Arthrocentesis (outpatient) | $513 | N/A | $513 |
| MRI - Back (outpatient) | $1,556 | N/A | $1,556 |
| MRI - Knee (outpatient) | $1,600 | N/A | $1,600 |
| MRI - Shoulder, Elbow, or Wrist | $1,574 | N/A | $1,574 |
| Physical Therapy - Application of Blood Vessel Compression or Decompression Device | $53 | 
Below Average
State Average: 3 | $53 |
| Physical Therapy - Low Complexity Evaluation | $268 | 
Near Average
State Average: 1 | $268 |
| Physical Therapy - Manual Therapy | $143 |
Below Average
State Average: 4 | $143 |
| Physical Therapy - Moderate Complexity Evaluation | $327 |
Near Average
State Average: 1 | $327 |
| Physical Therapy - Neuromuscular Reeducation | $89 | 
Above Average
State Average: 4 | $89 |
| Physical Therapy - Therapeutic Exercises | $91 |
Below Average
State Average: 4 | $91 |
| Test for Disease-Causing (Pathogenic) Organisms, Not Limited to a Specific Condition | $53 | N/A | $53 |
| X-Ray - Ankle (outpatient) | $332 | N/A | $332 |
| X-Ray - Foot (outpatient) | $306 | N/A | $306 |
| X-Ray - Hand | $431 | N/A | $431 |
| X-Ray - Hip | $347 | N/A | $347 |
| X-Ray - Knee (outpatient) | $420 | N/A | $420 |
| X-Ray - Neck, Cervical Spine | $413 | N/A | $413 |
| X-Ray - Pelvis | $314 | N/A | $314 |
| X-Ray - Shoulder (outpatient) | $423 | N/A | $423 |
| X-Ray - Spine (outpatient) | $443 | N/A | $443 |
| X-Ray - Wrist (outpatient) | $443 | N/A | $443 |
