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 |
|---|---|---|---|---|---|
| Range of Motion Measurements, Hand Procedure | 95852 | $20.00 | $18.00 | $17.00 | $16.00 |
| Removal of Earwax Using Instrumentation Procedure | 69210 | $45.00 | $40.50 | $38.25 | $36.00 |
| Removal of Earwax Using Irrigation and/or Lavage Procedure | 69209 | $15.00 | $13.50 | $12.75 | $12.00 |
| Removal of Foreign Body, Auditory Canal Procedure | 69200 | $70.00 | $63.00 | $59.50 | $56.00 |
| Removal of Foreign Body, Intranasal Procedure | 30300 | $170.00 | $153.00 | $144.50 | $136.00 |
| Removal of Skin Tags, Each Additional 10 Procedure | 11201 | $15.00 | $13.50 | $12.75 | $12.00 |
| Removal of Skin Tags, Up to 15 Procedure | 11200 | $80.00 | $72.00 | $68.00 | $64.00 |
| Respiratory Flow Volume Loop Procedure | 94375 | $35.00 | $31.50 | $29.75 | $28.00 |
| Simple Biopsy of Vaginal Mucosa Procedure | 57100 | $105.00 | $94.50 | $89.25 | $84.00 |
| Simple Destruction of One or More Vulvar Lesions Procedure | 56501 | $160.00 | $144.00 | $136.00 | $128.00 |
| Simple Incision and Removal of Foreign Body Procedure | 10120 | $140.00 | $126.00 | $119.00 | $112.00 |
| Sutures: Removal Not Requiring Anesthesia per Unit Procedure | 15854 | $12.00 | $10.80 | $10.20 | $9.60 |
| Sutures: Removal Not Requiring Anesthesia per Unit Procedure | 15853 | $10.00 | $9.00 | $8.50 | $8.00 |
| Sutures: Removal Requiring Anesthesia per Unit Procedure | 15851 | $50.00 | $45.00 | $42.50 | $40.00 |
| Tympanometry Procedure | 92567 | $15.00 | $13.50 | $12.75 | $12.00 |
| Vaginal Irrigation and/or Application of Medication Procedure | 57150 | $60.00 | $54.00 | $51.00 | $48.00 |
| Wound: Complex Postoperative Infection Procedure | 10180 | $240.00 | $216.00 | $204.00 | $192.00 |
| Wound: Complex Repair, 1.1 cm to 2.5 cm Procedure | 13131 | $335.00 | $301.50 | $284.75 | $268.00 |
| Wound: Complex Repair of Wound, 2.6 cm to 7.5 cm Procedure | 13132 | $460.00 | $414.00 | $391.00 | $368.00 |
| Wound: Intermediate Repair, 2.5 cm or Less Procedure | 12041 | $220.00 | $198.00 | $187.00 | $176.00 |
“—”: the plan has no special price for that service; its benefits or the price without membership apply.
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