Price lookup
Search a service and see its price with and without membership.
Member fee schedule, version 1
416 services
| Service | Code | Price without membership | Essential | Plus | Premier |
|---|---|---|---|---|---|
| Colposcopy w/ Biopsy of Cervix and Endocervical Curettage Procedure | 57454 | $150.00 | $135.00 | $127.50 | $120.00 |
| Colposcopy w/ Biopsy of Cervix and/or Endocervical Curettage Procedure | 57455 | $140.00 | $126.00 | $119.00 | $112.00 |
| Colposcopy w/ LEEP Biopsy Procedure | 57460 | $260.00 | $234.00 | $221.00 | $208.00 |
| Colposcopy w/ LEEP Cone Procedure | 57461 | $300.00 | $270.00 | $255.00 | $240.00 |
| Conization of Cervix (Cone Biopsy) Procedure | 57520 | $305.00 | $274.50 | $259.25 | $244.00 |
| Control Nasal Hemorrhage, Complex Anterior Procedure | 30903 | $200.00 | $180.00 | $170.00 | $160.00 |
| Control Nasal Hemorrhage, Initial Posterior Procedure | 30905 | $290.00 | $261.00 | $246.50 | $232.00 |
| Control Nasal Hemorrhage, Simple Anterior Procedure | 30901 | $130.00 | $117.00 | $110.50 | $104.00 |
| Control Nasal Hemorrhage, Subsequent Posterior Procedure | 30906 | $320.00 | $288.00 | $272.00 | $256.00 |
| Cutting of Benign Hyperkeratotic Lesion, Single Procedure | 11055 | $60.00 | $54.00 | $51.00 | $48.00 |
| Destruction of Benign Lesions, 15 or More Procedure | 17111 | $115.00 | $103.50 | $97.75 | $92.00 |
| Destruction of Benign Lesions, Up to 14 Procedure | 17110 | $95.00 | $85.50 | $80.75 | $76.00 |
| Destruction of Premalignant Lesion, 15 or More Procedure | 17004 | $140.00 | $126.00 | $119.00 | $112.00 |
| Destruction of Premalignant Lesion, 2 to 14 Procedure | 17003 | $8.00 | $7.20 | $6.80 | $6.40 |
| Destruction of Premalignant Lesion, Single Procedure | 17000 | $60.00 | $54.00 | $51.00 | $48.00 |
| Destruction of Vaginal Lesions, Extensive Procedure | 57065 | $250.00 | $225.00 | $212.50 | $200.00 |
| Destruction of Vaginal Lesions, Simple Procedure | 57061 | $170.00 | $153.00 | $144.50 | $136.00 |
| Ear Piercing Procedure | 69090 | $35.00 | $31.50 | $29.75 | $28.00 |
| EKG Procedure | 93000 | $20.00 | $18.00 | $17.00 | $16.00 |
| Endometrial Sampling (Biopsy) Procedure | 58100 | $85.00 | $76.50 | $72.25 | $68.00 |
“—”: the plan has no special price for that service; its benefits or the price without membership apply.
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