| Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $94.15 | $84.08 | 1.1x | 0.50x |
| Insertion of needle into vein for collection of blood sample | $7.36 | $7.07 | 1.0x | 0.34x |
| Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | $8.46 | $7.57 | 1.1x | 0.23x |
| Ground mileage, per statute mile | $8.79 | $8.53 | 1.0x | 0.33x |
| Blood test, comprehensive group of blood chemicals | $11.45 | $10.29 | 1.1x | 0.19x |
| Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $154.63 | $119.66 | 1.3x | 0.56x |
| Blood test, lipids (cholesterol and triglycerides) | $14.46 | $13.04 | 1.1x | 0.15x |
| Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $125.99 | $74.35 | 1.7x | 0.62x |
| Blood test, thyroid stimulating hormone (tsh) | $18.05 | $16.35 | 1.1x | 0.19x |
| Hemoglobin a1c level | $10.77 | $9.46 | 1.1x | 0.19x |
| Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | $32.25 | $22.82 | 1.4x | 0.47x |
| Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $190.31 | $110.17 | 1.7x | 0.58x |
| Manual urinalysis test with examination using microscope, automated | $3.47 | $3.09 | 1.1x | 0.11x |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report | $22.93 | $13.92 | 1.6x | 0.33x |
| New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | $123.69 | $106.14 | 1.2x | 0.47x |
| Urine microalbumin (protein) level | $6.55 | $5.64 | 1.2x | 0.11x |
| Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge | $10.24 | $9.80 | 1.0x | 0.65x |
| Vitamin d-3 level | $31.70 | $28.79 | 1.1x | 0.17x |
| Application of ultrasound, each 15 minutes | $15.55 | $10.11 | 1.5x | 0.41x |
| Pathology examination of tissue using a microscope, intermediate complexity | $83.10 | $62.18 | 1.3x | 0.45x |
| Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $58.79 | $51.06 | 1.2x | 0.50x |
| Established patient problem focused exam of visual system | $90.96 | $85.55 | 1.1x | 0.54x |
| Creatinine level to test for kidney function or muscle injury | $5.70 | $5.06 | 1.1x | 0.12x |
| Thyroxine (thyroid chemical), free | $9.98 | $8.79 | 1.1x | 0.11x |
| X-ray of chest, 1 view | $23.84 | $9.18 | 2.6x | 0.46x |
| Bacterial urine culture | $9.11 | $7.89 | 1.2x | 0.29x |
| Cyanocobalamin (vitamin b-12) level | $16.23 | $14.68 | 1.1x | 0.18x |
| Emergency department visit with high level of medical decision making | $1,420.83 | $176.24 | 8.1x | 1.15x |
| Blood test, basic group of blood chemicals (calcium, total) | $9.18 | $8.25 | 1.1x | 0.19x |
| Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $312.09 | $166.99 | 1.9x | 0.55x |
| Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | $36.72 | $7.75 | 4.7x | 0.82x |
| Imaging of retina | $88.95 | $39.00 | 2.3x | 0.72x |
| Psa (prostate specific antigen) measurement, total | $19.71 | $17.92 | 1.1x | 0.19x |
| Ultrasound of heart with color-depicted blood flow, rate, direction and valve function | $218.09 | $150.10 | 1.5x | 0.46x |
| Chiropractic manipulative treatment, 3-4 spinal regions | $40.87 | $37.74 | 1.1x | 0.67x |
| New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more | $203.05 | $160.02 | 1.3x | 0.50x |
| Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution | $15.71 | $8.46 | 1.9x | 0.29x |
| Critical care, first 30-74 minutes | $803.74 | $206.70 | 3.9x | 0.77x |
| Complete blood cell count (red cells, white blood cell, platelets), automated test | $6.88 | $6.31 | 1.1x | 0.22x |
| Emergency department visit with low level of medical decision making | $117.38 | $67.43 | 1.7x | 0.29x |