Medical Procedure Costs

59148011480

ABILIFY ASIMTUFII 960 MG/3.2 ML

Prescription Drug - Brand

$1,782

—

59148023212

ABILIFY MAINTENA ER 300 MG VL

Prescription Drug - Brand

$2,139

—

59148024512

ABILIFY MAINTENA ER 400 MG VL

Prescription Drug - Brand

$2,856

—

59148064023

ABILIFY DISCMELT 10 MG TABLET

Prescription Drug - Brand

$35

—

59148064123

ABILIFY DISCMELT 15 MG TABLET

Prescription Drug - Brand

$34

—

59150

Treat ectopic pregnancy

Surgery - Maternity

$713

—

59151

Treat ectopic pregnancy

Surgery - Maternity

$694

—

59160

D & c after delivery

Surgery - Maternity

$168

—

59200

Insert cervical dilator

Surgery - Maternity

$60

—

59212020010

UROXATRAL 10 MG TABLET

Prescription Drug - Brand

$18

—

59212056210

PLAQUENIL 200 MG TABLET

Prescription Drug - Brand

$9

—

59212065860

KAPVAY ER 0.1 MG TABLET

Prescription Drug - Brand

$7

—

59300

Episiotomy or vaginal repair

Surgery - Maternity

$134

—

59310011106

AIRDUO DIGIHALER 55-14 MCG

Prescription Drug - Brand

$420

—

59310011720

PROAIR DIGIHALER 90 MCG INHALR

Prescription Drug - Brand

$86

—

59310012906

AIRDUO DIGIHALER 113-14 MCG

Prescription Drug - Brand

$419

—

59310013606

AIRDUO DIGIHALER 232-14 MCG

Prescription Drug - Brand

$474

—

59310020006

ARMONAIR DIGIHALER 113 MCG

Prescription Drug - Brand

$252

—

59310020212

QVAR 40 MCG ORAL INHALER

Prescription Drug - Brand

$19

—

59310020412

QVAR 80 MCG ORAL INHALER

Prescription Drug - Brand

$25

—

59310030240

QVAR REDIHALER 40 MCG

Prescription Drug - Brand

$21

—

59310030480

QVAR REDIHALER 80 MCG

Prescription Drug - Brand

$28

—

59310040606

QNASL CHILDREN'S 40 MCG SPRAY

Prescription Drug - Brand

$47

—

59310041012

QNASL 80 MCG NASAL SPRAY

Prescription Drug - Brand

$30

—

59310057922

PROAIR HFA 90 MCG INHALER

Prescription Drug - Brand

$8

—

59310058020

PROAIR RESPICLICK INHAL POWDER

Prescription Drug - Brand

$58

—

59310081206

AIRDUO RESPICLICK 113-14 MCG

Prescription Drug - Brand

$386

—

59310082206

AIRDUO RESPICLICK 232-14 MCG

Prescription Drug - Brand

$385

—

59316010228

BIOFREEZE 4% GEL

Prescription Drug - Brand

$0

—

59316020714

BIOFREEZE 4% GEL ROLL-ON

Prescription Drug - Brand

$0

—

59316083310

BIOFREEZE 10.5% SPRAY

Prescription Drug - Brand

$0

—

59320

Revision of cervix

Surgery - Maternity

$137

—

59325

Revision of cervix

Surgery - Maternity

$215

—

59350

Repair of uterus

Surgery - Maternity

$246

—

59365503000

TRIMO-SAN JELLY

Prescription Drug - Brand

$0

—

59385001230

BUNAVAIL 2.1-0.3 MG FILM

Prescription Drug - Brand

$8

—

59385001430

BUNAVAIL 4.2-0.7 MG FILM

Prescription Drug - Brand

$8

—

59385001630

BUNAVAIL 6.3-1 MG FILM

Prescription Drug - Brand

$17

—

59385002160

BELBUCA 75 MCG FILM

Prescription Drug - Brand

$8

—

59385002260

BELBUCA 150 MCG FILM

Prescription Drug - Brand

$8

—

59385002360

BELBUCA 300 MCG FILM

Prescription Drug - Brand

$12

—

59385002460

BELBUCA 450 MCG FILM

Prescription Drug - Brand

$16

—

59385002560

BELBUCA 600 MCG FILM

Prescription Drug - Brand

$17

—

59385002660

BELBUCA 750 MCG FILM

Prescription Drug - Brand

$18

—

59385002760

BELBUCA 900 MCG FILM

Prescription Drug - Brand

$19

—

59385004130

SYMPROIC 0.2 MG TABLET

Prescription Drug - Brand

$16

—

59400

Obstetrical care

Surgery - Maternity

$2,214

—

59409

Obstetrical care

Surgery - Maternity

$722

—

59410

Obstetrical care

Surgery - Maternity

$976

—

59412

Antepartum manipulation

Surgery - Maternity

$94

—

My Cost List