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Tarifario de miembros, versión 1
416 servicios
| Servicio | Código | Precio sin membresía | Essential | Plus | Premier |
|---|---|---|---|---|---|
| Psychotherapy for Crisis, Additional 30 Minutes Office Visit | 90840 | $85.00 | $59.50 | $51.00 | $42.50 |
| Retinal Photography Office Visit | SRV-L422NS | $20.00 | $18.00 | $17.00 | $16.00 |
| Abcess: Incision and Drainage, Complex/Multiple Abscess Procedure | 10061 | $190.00 | $171.00 | $161.50 | $152.00 |
| Abcess: Incision and Drainage, Single/Simple Procedure | 10060 | $110.00 | $99.00 | $93.50 | $88.00 |
| Airway Inhalation Treatment Procedure | 94640 | $10.00 | $9.00 | $8.50 | $8.00 |
| Apply Fluoride Varnish Procedure | 99188 | $30.00 | $27.00 | $25.50 | $24.00 |
| Auditory Evoked Potentials, Screening Procedure | 92650 | $80.00 | $72.00 | $68.00 | $64.00 |
| Auditory Evoked Potentials, Threshold Procedure | 92652 | $95.00 | $85.50 | $80.75 | $76.00 |
| Biopsy of Cervix, Single or Multiple, or Local Excision of Lesion Procedure | 57500 | $130.00 | $117.00 | $110.50 | $104.00 |
| Biopsy of Each Additional Lesion on Vulva or Perineum Procedure | 56606 | $35.00 | $31.50 | $29.75 | $28.00 |
| Biopsy of Single Lesion on Vulva or Perineum Procedure | 56605 | $80.00 | $72.00 | $68.00 | $64.00 |
| Chemical Cauterization of Granulation Tissue Procedure | 17250 | $70.00 | $63.00 | $59.50 | $56.00 |
| Circumcision, 28 Days or Older Procedure | 54161 | $170.00 | $153.00 | $144.50 | $136.00 |
| CMT for All five Spinal Regions Procedure | 98942 | $45.00 | $40.50 | $38.25 | $36.00 |
| CMT for Extraspinal Regions Procedure | 98943 | $45.00 | $40.50 | $38.25 | $36.00 |
| CMT for One to Two Spinal Regions Procedure | 98940 | $25.00 | $22.50 | $21.25 | $20.00 |
| CMT for Three to Four Spinal Regions Procedure | 98941 | $35.00 | $31.50 | $29.75 | $28.00 |
| Colcoscopy of Cervix w/ Endocervical Curettage, w/o Biopsy Procedure | 57456 | $130.00 | $117.00 | $110.50 | $104.00 |
| Colposcopy of the Vulva without Biopsy Procedure | 56820 | $234.00 | $210.60 | $198.90 | $187.20 |
| Colposcopy (Vaginoscopy) of Cervix Procedure | 57452 | $120.00 | $108.00 | $102.00 | $96.00 |
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