Medical Procedure Costs

59011075104

BUTRANS 10 MCG/HR PATCH

Prescription Drug - Brand

$74

—

59011075204

BUTRANS 20 MCG/HR PATCH

Prescription Drug - Brand

$131

—

59011075704

BUTRANS 7.5 MCG/HR PATCH

Prescription Drug - Brand

$69

—

59011075804

BUTRANS 15 MCG/HR PATCH

Prescription Drug - Brand

$125

—

59012

Fetal cord puncture prenatal

Surgery - Maternity

$180

—

59015

Chorion biopsy

Surgery - Maternity

$118

—

59020

Fetal contract stress test

Surgery - Maternity

$73

—

59025

Fetal non-stress test

Surgery - Maternity

$50

—

59030

Fetal scalp blood sampling

Surgery - Maternity

$99

—

59050

Fetal monitor w/report

Surgery - Maternity

$44

—

59051

Fetal monitor/interpret only

Surgery - Maternity

$36

—

59070

Transabdom amnioinfus w/us

Surgery - Maternity

$276

—

59072

Umbilical cord occlud w/us

Surgery - Maternity

$463

—

59074

Fetal fluid drainage w/us

Surgery - Maternity

$276

—

59076

Fetal shunt placement w/us

Surgery - Maternity

$463

—

59088011266

PUREVIT DUALFE PLUS CAPSULE

Prescription Drug - Generic

$0

—

59088081920

LIDOCAINE-HC 3-0.5% CREAM KIT

Prescription Drug - Generic

$91

—

59088090984

LIDOCAN V 5% PATCH

Prescription Drug - Generic

$2

—

59088091084

LIDOCAN IV 5% PATCH

Prescription Drug - Generic

$2

—

59100

Remove uterus lesion

Surgery - Maternity

$771

—

59120

Treat ectopic pregnancy

Surgery - Maternity

$735

—

59121

Treat ectopic pregnancy

Surgery - Maternity

$735

—

591288601

VERAPAMIL 360 MG CAP PELLET

Prescription Drug - Generic

$5

—

59130

Treat ectopic pregnancy

Surgery - Maternity

$852

—

59136

Treat ectopic pregnancy

Surgery - Maternity

$808

—

59137050504

RASUVO 7.5 MG/0.15 ML AUTOINJ

Prescription Drug - Brand

$960

—

59137051004

RASUVO 10 MG/0.2 ML AUTOINJ

Prescription Drug - Brand

$722

—

59137051504

RASUVO 12.5 MG/0.25 ML AUTOINJ

Prescription Drug - Brand

$575

—

59137052004

RASUVO 15 MG/0.3 ML AUTOINJ

Prescription Drug - Brand

$482

—

59137052504

RASUVO 17.5 MG/0.35 ML AUTOINJ

Prescription Drug - Brand

$410

—

59137053004

RASUVO 20 MG/0.4 ML AUTOINJ

Prescription Drug - Brand

$361

—

59137054004

RASUVO 25 MG/0.5 ML AUTOINJ

Prescription Drug - Brand

$288

—

59140

Treat ectopic pregnancy

Surgery - Maternity

$380

—

59148000613

ABILIFY 2 MG TABLET

Prescription Drug - Brand

$19

—

59148000713

ABILIFY 5 MG TABLET

Prescription Drug - Brand

$19

—

59148000813

ABILIFY 10 MG TABLET

Prescription Drug - Brand

$19

—

59148000913

ABILIFY 15 MG TABLET

Prescription Drug - Brand

$19

—

59148001013

ABILIFY 20 MG TABLET

Prescription Drug - Brand

$26

—

59148001113

ABILIFY 30 MG TABLET

Prescription Drug - Brand

$26

—

59148001315

ABILIFY 1 MG/ML SOLUTION

Prescription Drug - Brand

$6

—

59148002050

SAMSCA 15 MG TABLET

Prescription Drug - Brand

$300

—

59148003513

REXULTI 0.25 MG TABLET

Prescription Drug - Brand

$50

—

59148003613

REXULTI 0.5 MG TABLET

Prescription Drug - Brand

$50

—

59148003713

REXULTI 1 MG TABLET

Prescription Drug - Brand

$50

—

59148003813

REXULTI 2 MG TABLET

Prescription Drug - Brand

$50

—

59148003913

REXULTI 3 MG TABLET

Prescription Drug - Brand

$50

—

59148004013

REXULTI 4 MG TABLET

Prescription Drug - Brand

$50

—

59148004580

ABILIFY MAINTENA ER 300 MG SYR

Prescription Drug - Brand

$2,143

—

59148007280

ABILIFY MAINTENA ER 400 MG SYR

Prescription Drug - Brand

$2,860

—

59148010280

ABILIFY ASIMTUFII 720 MG/2.4 ML

Prescription Drug - Brand

$1,776

—

My Cost List