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 |
|---|---|---|---|---|---|
| Pelvic Limited Ultrasound | 76857 | $100.00 | $90.00 | $85.00 | $80.00 |
| Penile Vascular Duplex – Complete Ultrasound | 93980 | $100.00 | $90.00 | $85.00 | $80.00 |
| Penile Vascular Duplex – Limited Ultrasound | 93981 | $100.00 | $90.00 | $85.00 | $80.00 |
| Renal Doppler Ultrasound | 76776 | $100.00 | $90.00 | $85.00 | $80.00 |
| Renal / Retroperitoneal – Complete Ultrasound | 76770 | $100.00 | $90.00 | $85.00 | $80.00 |
| Renal / Retroperitoneal – Limited Ultrasound | 76775 | $100.00 | $90.00 | $85.00 | $80.00 |
| Scrotum and Contents Ultrasound | 76870 | $100.00 | $90.00 | $85.00 | $80.00 |
| Spinal Canal Ultrasound | 76800 | $200.00 | $180.00 | $170.00 | $160.00 |
| Transrectal, Prostate Ultrasound | 76872 | $100.00 | $90.00 | $85.00 | $80.00 |
| Transrectal, Volume Study Ultrasound | 76873 | $100.00 | $90.00 | $85.00 | $80.00 |
| Transvaginal Ultrasound | 76830 | $100.00 | $90.00 | $85.00 | $80.00 |
| Umbilical Artery Doppler Ultrasound | 76820 | $100.00 | $90.00 | $85.00 | $80.00 |
| Upper Extremity Arterial Duplex – Bilateral / Complete Ultrasound | 93930 | $150.00 | $135.00 | $127.50 | $120.00 |
| Upper Extremity Arterial Duplex – Unilateral / Limited Ultrasound | 93931 | $150.00 | $135.00 | $127.50 | $120.00 |
| Upper / Lower Extremity Physiological Study, Complete & Bilateral Ultrasound | 93923 | $100.00 | $90.00 | $85.00 | $80.00 |
| Upper / Lower Extremity Physiological Study, Limited & Bilateral Ultrasound | 93922 | $100.00 | $90.00 | $85.00 | $80.00 |
“—”: the plan has no special price for that service; its benefits or the price without membership apply.
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