| Ground mileage, per statute mile | $23.00 | $9.98 | 2.3x | 0.87x |
| Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $225.52 | $106.45 | 2.1x | 0.82x |
| Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $162.46 | $76.29 | 2.1x | 0.86x |
| 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 | $1.09 | 1.0x | 0.65x |
| Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | $60.76 | $21.00 | 2.9x | 0.88x |
| Therapy procedure using functional activities | $70.74 | $28.35 | 2.5x | 0.95x |
| Insertion of needle into vein for collection of blood sample | $14.88 | $8.16 | 1.8x | 0.68x |
| Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $170.02 | $71.87 | 2.4x | 0.84x |
| Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | $68.09 | $24.13 | 2.8x | 0.94x |
| 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 | $32.70 | $14.82 | 2.2x | 0.75x |
| Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | $27.86 | $7.59 | 3.7x | 0.75x |
| Blood test, comprehensive group of blood chemicals | $38.50 | $10.33 | 3.7x | 0.63x |
| Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $317.92 | $108.57 | 2.9x | 0.98x |
| Therapy procedure using manual technique, each 15 minutes | $60.60 | $18.96 | 3.2x | 0.89x |
| Destruction of precancer skin growth, 2-14 growths | $19.27 | $5.53 | 3.5x | 0.88x |
| Detection test by nucleic acid for organism, amplified probe technique | $52.81 | $34.33 | 1.5x | 0.83x |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | $35.46 | $7.57 | 4.7x | 0.79x |
| Chiropractic manipulative treatment, 3-4 spinal regions | $59.32 | $36.27 | 1.6x | 0.98x |
| X-ray of chest, 1 view | $63.34 | $8.36 | 7.6x | 1.21x |
| Blood test, lipids (cholesterol and triglycerides) | $52.37 | $13.09 | 4.0x | 0.55x |
| Hemoglobin a1c level | $36.68 | $9.48 | 3.9x | 0.63x |
| New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | $328.26 | $146.33 | 2.2x | 0.80x |
| Rotary wing air mileage, per statute mile | $360.89 | $40.73 | 8.9x | 1.01x |
| Injection of drug or substance under skin or into muscle | $47.30 | $12.03 | 3.9x | 0.86x |
| Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | $170.81 | $92.02 | 1.9x | 0.81x |
| Blood test, thyroid stimulating hormone (tsh) | $67.10 | $16.44 | 4.1x | 0.70x |
| Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more | $134.81 | $63.46 | 2.1x | 0.87x |
| Emergency department visit with high level of medical decision making | $1,324.41 | $161.94 | 8.2x | 1.07x |
| Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | $257.61 | $96.36 | 2.7x | 0.92x |
| Administration of influenza virus vaccine | $36.62 | $27.50 | 1.3x | 0.90x |
| Pathology examination of tissue using a microscope, intermediate complexity | $142.36 | $44.16 | 3.2x | 0.77x |
| Professional service for preparation and provision of 1 or more antigens | $23.91 | $12.76 | 1.9x | 0.81x |
| Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $528.87 | $158.64 | 3.3x | 0.93x |
| Established patient complete exam of visual system | $183.09 | $112.85 | 1.6x | 0.81x |
| Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more | $341.99 | $147.05 | 2.3x | 0.84x |
| Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge | $11.07 | $10.84 | 1.0x | 0.70x |
| New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | $225.97 | $95.66 | 2.4x | 0.85x |
| Automated urinalysis test | $12.69 | $2.19 | 5.8x | 0.84x |
| Imaging of retina | $85.40 | $36.21 | 2.4x | 0.69x |
| X-ray of chest, 2 views | $68.01 | $15.16 | 4.5x | 0.95x |