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 |
|---|---|---|---|---|---|
| Hyperbaric Chamber - 5 Session Procedure | SRV-HL854Y | $130.00 | $117.00 | $110.50 | $104.00 |
| Incision and Drainage of Bartholin's Gland Abscess Procedure | 56420 | $155.00 | $139.50 | $131.75 | $124.00 |
| Incision and Drainage of Vulva or Perineal Abscess Procedure | 56405 | $130.00 | $117.00 | $110.50 | $104.00 |
| Induction of Vomiting Procedure | 99175 | $25.00 | $22.50 | $21.25 | $20.00 |
| IUD Insertion Procedure | 58300 | $150.00 | $135.00 | $127.50 | $120.00 |
| IUD Removal Procedure | 58301 | $150.00 | $135.00 | $127.50 | $120.00 |
| Lysis of Penile Post-Circumicision Adhesions Procedure | 54162 | $220.00 | $198.00 | $187.00 | $176.00 |
| Marsupialization of Bartholin's Gland Cyst Procedure | 56440 | $160.00 | $144.00 | $136.00 | $128.00 |
| Medical Nutrition Therapy Initial Procedure | 97802 | $35.00 | $31.50 | $29.75 | $28.00 |
| Medical Nutrition Therapy Subsequent Procedure | 97803 | $30.00 | $27.00 | $25.50 | $24.00 |
| Nebulizer Procedure | SRV-F6ER6S | $30.00 | $27.00 | $25.50 | $24.00 |
| Nexplanon Insertion Procedure | 11981 | $150.00 | $135.00 | $127.50 | $120.00 |
| Nexplanon Removal Procedure | 11982 | $150.00 | $135.00 | $127.50 | $120.00 |
| Nexplanon Removal w/ Reinsertion of Replacement Procedure | 11983 | $190.00 | $171.00 | $161.50 | $152.00 |
| Nonobstetrical dilation and curettage, or D&C Procedure | 58120 | $320.00 | $288.00 | $272.00 | $256.00 |
| Pap Specimen Collection Procedure | Q0091 | $80.00 | $72.00 | $68.00 | $64.00 |
| Puncture Aspiration of Abscess, Hematoma, Bulla, or Cyst Procedure | 10160 | $110.00 | $99.00 | $93.50 | $88.00 |
| Pure Tone Audiometry, Screening Procedure | 92551 | $30.00 | $27.00 | $25.50 | $24.00 |
| Pure Tone Audiometry, Threshold Procedure | 92552 | $35.00 | $31.50 | $29.75 | $28.00 |
| Range of Motion Measurements, Each Extremity Procedure | 95851 | $20.00 | $18.00 | $17.00 | $16.00 |
“—”: the plan has no special price for that service; its benefits or the price without membership apply.
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