CIGNET HEALTH PLAN

P.O.BOX 6500

LARGO MD 20792

Tel: 301-423-4551

 

PROVIDER SERVICES PRICE LIST - USA

 

 

ITEM#

OFFICE SERVICE/

PROCEDURES

 

CIGNET CPT

CODE

Average Provider Health Cost

CIGNET DISCOUNTED PRICES

1

OFFICE CONSULT

99245

$210

$105

2

FOLLOWUP CONSULT

99244

$130

$65

3

NEW OFFICE VISIT

99205

$255

$85

4

FOLLOWUP VISIT

99215

$100

$50

5

NON DOCTOR FOLLOW UP

99212

$30

$15

6

NEW HOSPITAL VISIT

99223

$255

$85

7

FOLLOW UP HOSPITAL VISIT

99233

$100

$50

8

NEW HOSPITAL CONSULT

99255

$190

$95

9

FOLLOW UP HOSPITAL CONSULT

99254

$165

$55

10

COLPOSCOPY

57454

$130

$65

11

2DECHO

93320

$400

$200

12

ALL OFFICE X-RAYS

71020

$105

$35

13

MAMMOGRAM

76645

$150

$75

14

EKG

93000

$50

$25

15

ALL OFFICE SONOGRAMS

76815

$180

$60

16

STRESS TEST

93015

$170

$85

17

OB MONITORING

59020

$70

$35

18

VAGINAL DELIVERY

59409

$2,250

$750

19

C-SECTION

59510

$1,950

$975

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CIGNET HEALTH PLAN

P.O.BOX 6500

LARGO MD 20792

Tel: 301-423-4551

 

SPECIAL PRICING - LABORATORY - CIGNET HEALTH PLAN

 

ITEM#

OFFICE SERVICE/

PROCEDURES

 

UNIT COST

1

ALPHA FETO PROTEIN

$20.00

2

BETA-HCG, (STAT)

$25.00

3

BETA-HCG (QUANT)

$25.00

4

CBC

 

$8.00

5

CHLAMYDIA ANTIBODY

$45.00

6

CHLAMYDIA T.  PRO                                     

$30.00

7

CULTURE, VAGINAL

$20.00

8

CULTURE, URINE

$16.00

9

CULTURE, THROAT

$20.00

10

CHEM7, CHEM14, CHEM25

$25.00

11

FERRITIN

$20.00

12

FSH

$24.00

13

GROUP B STREP

$20.00

14

GLUCOSE

$10.00

15

HEPATITIS B PROFILE

$75.00

16

HEPATITIS C PROFILE

$75.00

17

HIV SCREEN

$30.00

18

LIPID PANEL

$20.00

19

LEAD

$30.00

20

LIVER PROFILE

$30.00

21

PAP SMEAR (THIN PREP)

$50.00

22

PROLACTIN

$20.00

23

PT, PTT

$20.00

24

RPR

$15.00

25

T3-FREE

$20.00

26

T3 – RIA

$20.00

27

URINALYSIS

$10.00

28

URINE PREGNANCY

$10.00

29

URIC ACID

$15.00

30

VARICELLA

$25.00

30

VITAMIN B12

$30.00

31

WHITE BLOOD CELLS

$10.00