| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $56 | $56 | $56 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $71 | $81 | $91 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $109 | $109 | $110 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $164 | $180 | $196 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $216 | $231 | $246 |
| Office visit established patient minimal CPT 99211 • Office Visits | $22 | $22 | $22 |
| Office visit established patient straightforward CPT 99212 • Office Visits | $46 | $52 | $57 |
| Office visit established patient low complexity CPT 99213 • Office Visits | $30 | $30 | $30 |
| Office visit established patient moderate complexity CPT 99214 • Office Visits | $125 | $142 | $160 |
| Office visit established patient high complexity CPT 99215 • Office Visits | $173 | $174 | $176 |
| Initial hospital care low complexity CPT 99221 • Office Visits | $30 | $30 | $30 |
| Initial hospital care moderate complexity CPT 99222 • Office Visits | $30 | $30 | $30 |
| Initial hospital care high complexity CPT 99223 • Office Visits | $30 | $30 | $30 |
| Subsequent hospital care low complexity CPT 99231 • Office Visits | $30 | $30 | $30 |
| Subsequent hospital care moderate complexity CPT 99232 • Office Visits | $30 | $30 | $30 |
| Subsequent hospital care high complexity CPT 99233 • Office Visits | $30 | $30 | $30 |
| Hospital discharge day management 30 minutes or less CPT 99238 • Office Visits | $30 | $30 | $30 |
| Hospital discharge day management more than 30 min CPT 99239 • Office Visits | $110 | $120 | $130 |
| Consultation office low complexity CPT 99243 • Office Visits | $171 | $171 | $171 |
| Consultation office high complexity CPT 99245 • Office Visits | $255 | $255 | $255 |
| Therapeutic exercises each 15 minutes CPT 97110 • Physical Therapy | $18 | $18 | $18 |
| Neuromuscular reeducation each 15 minutes CPT 97112 • Physical Therapy | $21 | $21 | $21 |
| Manual therapy one or more regions each 15 min CPT 97140 • Physical Therapy | $17 | $17 | $17 |
| Group therapeutic procedures CPT 97150 • Physical Therapy | $11 | $11 | $11 |
| Physical therapy evaluation low complexity CPT 97161 • Physical Therapy | $61 | $61 | $61 |
| Physical therapy evaluation moderate complexity CPT 97162 • Physical Therapy | $61 | $61 | $61 |
| Therapeutic activities each 15 minutes CPT 97530 • Physical Therapy | $23 | $23 | $23 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $10 | $10 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $10 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $58 | $58 | $58 |
| Circumcision CPT 54150 • Urology | $44 | $44 | $44 |