| Blood typing Rh CPT 86901 • Laboratory | $4 | $4 | $4 |
| Urine culture bacterial colony count CPT 87086 • Laboratory | $3 | $7 | $11 |
| Chlamydia nucleic acid amplification CPT 87491 • Laboratory | $15 | $32 | $49 |
| Gonorrhea nucleic acid amplification CPT 87591 • Laboratory | $15 | $32 | $49 |
| SARS-CoV-2 COVID-19 amplified probe CPT 87635 • Laboratory | $32 | $52 | $72 |
| Influenza virus assay with direct optical CPT 87804 • Laboratory | $10 | $17 | $23 |
| Fetal non-stress test CPT 59025 • Maternity | $33 | $49 | $64 |
| Insertion cervical dilator CPT 59200 • Maternity | $55 | $55 | $55 |
| Vaginal delivery including prenatal and postpartum care CPT 59400 • Maternity | $2,453 | $2,453 | $2,453 |
| Vaginal delivery only CPT 59409 • Maternity | $795 | $795 | $795 |
| Vaginal delivery including postpartum care CPT 59410 • Maternity | $1,031 | $1,031 | $1,031 |
| Antepartum care 7 or more visits CPT 59426 • Maternity | $250 | $250 | $250 |
| Postpartum care only CPT 59430 • Maternity | $210 | $210 | $210 |
| Cesarean delivery including prenatal and postpartum care CPT 59510 • Maternity | $2,579 | $3,048 | $3,517 |
| Cesarean delivery only CPT 59514 • Maternity | $148 | $516 | $885 |
| Cesarean delivery including postpartum care CPT 59515 • Maternity | $1,366 | $1,366 | $1,366 |
| Vaginal delivery after prior cesarean (VBAC) including prenatal CPT 59610 • Maternity | $2,429 | $2,429 | $2,429 |
| Obstetric ultrasound first trimester CPT 76801 • Maternity | $38 | $97 | $156 |
| Obstetric ultrasound complete CPT 76805 • Maternity | $115 | $147 | $180 |
| Obstetric ultrasound detailed fetal anatomy CPT 76811 • Maternity | $83 | $160 | $237 |
| Obstetric ultrasound limited CPT 76815 • Maternity | $25 | $66 | $107 |
| Ultrasound transvaginal obstetric CPT 76817 • Maternity | $83 | $103 | $123 |
| Interactive complexity add-on CPT 90785 • Mental Health | $13 | $13 | $13 |
| Psychiatric diagnostic evaluation CPT 90791 • Mental Health | $125 | $125 | $125 |
| Psychiatric diagnostic evaluation with medical services CPT 90792 • Mental Health | $106 | $106 | $106 |
| Psychotherapy 30 minutes CPT 90832 • Mental Health | $78 | $78 | $78 |
| Psychotherapy 30 min add-on to E/M CPT 90833 • Mental Health | $66 | $66 | $66 |
| Psychotherapy 45 minutes CPT 90834 • Mental Health | $82 | $82 | $82 |
| Psychotherapy 45 min add-on to E/M CPT 90836 • Mental Health | $84 | $84 | $84 |
| Psychotherapy 60 minutes CPT 90837 • Mental Health | $121 | $121 | $121 |
| Psychotherapy 60 min add-on to E/M CPT 90838 • Mental Health | $105 | $105 | $105 |
| Psychotherapy crisis first 60 minutes CPT 90839 • Mental Health | $120 | $120 | $120 |
| Psychotherapy crisis each additional 30 minutes CPT 90840 • Mental Health | $56 | $56 | $56 |
| Family psychotherapy without patient CPT 90846 • Mental Health | $104 | $104 | $104 |
| Family psychotherapy with patient CPT 90847 • Mental Health | $102 | $102 | $102 |
| Group psychotherapy CPT 90853 • Mental Health | $29 | $29 | $29 |
| Brief emotional/behavioral assessment CPT 96127 • Mental Health | $4 | $4 | $4 |
| Lumbar puncture diagnostic CPT 62270 • Neurology | $123 | $123 | $123 |
| Electroencephalogram (EEG) awake and asleep CPT 95816 • Neurology | $62 | $290 | $518 |
| Electroencephalogram (EEG) awake and asleep with activation CPT 95819 • Neurology | $596 | $596 | $596 |
| EMG needle each extremity complete CPT 95886 • Neurology | $53 | $79 | $104 |
| Nerve conduction study 3-4 nerves CPT 95908 • Neurology | $131 | $131 | $131 |
| Nerve conduction study 5-6 nerves CPT 95909 • Neurology | $150 | $150 | $150 |
| Nerve conduction study 7-8 nerves CPT 95910 • Neurology | $177 | $177 | $177 |
| Nerve conduction study 13 or more nerves CPT 95913 • Neurology | $318 | $318 | $318 |
| Office visit new patient straightforward CPT 99202 • Office Visits | $86 | $91 | $97 |
| Office visit new patient low complexity CPT 99203 • Office Visits | $92 | $120 | $149 |
| Office visit new patient moderate complexity CPT 99204 • Office Visits | $174 | $199 | $224 |
| Office visit new patient high complexity CPT 99205 • Office Visits | $273 | $285 | $296 |
| Office visit established patient minimal CPT 99211 • Office Visits | $27 | $29 | $31 |