| Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled | $1.13 | $1.10 | 1.0x | 0.65x |
| Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $293.18 | $116.75 | 2.5x | 1.07x |
| Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | $67.99 | $22.80 | 3.0x | 0.98x |
| Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $207.51 | $82.93 | 2.5x | 1.10x |
| Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $206.26 | $72.32 | 2.9x | 1.01x |
| Ground mileage, per statute mile | $34.58 | $9.52 | 3.6x | 1.31x |
| Therapy procedure using functional activities | $84.62 | $30.39 | 2.8x | 1.14x |
| Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $317.90 | $111.53 | 2.9x | 0.98x |
| Insertion of needle into vein for collection of blood sample | $27.46 | $8.58 | 3.2x | 1.26x |
| Therapy procedure using manual technique, each 15 minutes | $70.47 | $20.14 | 3.5x | 1.04x |
| Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | $73.48 | $26.54 | 2.8x | 1.01x |
| Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | $34.20 | $7.59 | 4.5x | 0.92x |
| Blood test, comprehensive group of blood chemicals | $68.05 | $10.32 | 6.6x | 1.11x |
| Destruction of precancer skin growth, 2-14 growths | $15.18 | $6.05 | 2.5x | 0.69x |
| Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more | $172.77 | $64.75 | 2.7x | 1.12x |
| Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $564.87 | $162.64 | 3.5x | 0.99x |
| Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's | $39.21 | $15.19 | 2.6x | 0.90x |
| Rotary wing air mileage, per statute mile | $392.01 | $38.28 | 10.2x | 1.10x |
| Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | $246.55 | $93.64 | 2.6x | 1.17x |
| Blood test, lipids (cholesterol and triglycerides) | $130.54 | $13.10 | 10.0x | 1.36x |
| Pathology examination of tissue using a microscope, intermediate complexity | $209.67 | $50.15 | 4.2x | 1.13x |
| X-ray of chest, 1 view | $76.46 | $8.38 | 9.1x | 1.46x |
| New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | $434.72 | $154.63 | 2.8x | 1.06x |
| Blood test, thyroid stimulating hormone (tsh) | $110.83 | $16.45 | 6.7x | 1.16x |
| Hemoglobin a1c level | $62.44 | $9.50 | 6.6x | 1.08x |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | $42.77 | $7.79 | 5.5x | 0.96x |
| Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more | $381.36 | $163.24 | 2.3x | 0.94x |
| Test for allergy using allergenic extract | $14.38 | $3.38 | 4.3x | 1.09x |
| Chiropractic manipulative treatment, 3-4 spinal regions | $66.27 | $38.17 | 1.7x | 1.09x |
| Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha) | $26.83 | $10.61 | 2.5x | 1.40x |
| Emergency department visit with high level of medical decision making | $1,542.66 | $165.92 | 9.3x | 1.25x |
| New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | $300.98 | $102.31 | 2.9x | 1.13x |
| Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month | $121.78 | $59.55 | 2.0x | 1.08x |
| Manual urinalysis test with examination using microscope, automated | $39.35 | $3.10 | 12.7x | 1.23x |
| Administration of influenza virus vaccine | $34.09 | $27.29 | 1.2x | 0.84x |
| Hospital discharge day management, more than 30 minutes | $376.37 | $109.25 | 3.4x | 1.06x |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report | $59.69 | $13.64 | 4.4x | 0.86x |
| Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month | $117.90 | $46.13 | 2.6x | 1.22x |
| Imaging of retina | $113.72 | $39.53 | 2.9x | 0.92x |
| Advance care planning, first 30 minutes | $151.32 | $70.62 | 2.1x | 0.81x |