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