Medical Procedure Costs

59414

Deliver placenta

Surgery - Maternity

$82

—

59417010110

VYVANSE 10 MG CAPSULE

Prescription Drug - Brand

$12

—

59417010210

VYVANSE 20 MG CAPSULE

Prescription Drug - Brand

$12

—

59417010310

VYVANSE 30 MG CAPSULE

Prescription Drug - Brand

$12

—

59417010410

VYVANSE 40 MG CAPSULE

Prescription Drug - Brand

$12

—

59417010510

VYVANSE 50 MG CAPSULE

Prescription Drug - Brand

$12

—

59417010610

VYVANSE 60 MG CAPSULE

Prescription Drug - Brand

$12

—

59417010710

VYVANSE 70 MG CAPSULE

Prescription Drug - Brand

$12

—

59417011501

VYVANSE 10 MG CHEWABLE TABLET

Prescription Drug - Brand

$12

—

59417011601

VYVANSE 20 MG CHEWABLE TABLET

Prescription Drug - Brand

$12

—

59417011701

VYVANSE 30 MG CHEWABLE TABLET

Prescription Drug - Brand

$12

—

59417011801

VYVANSE 40 MG CHEWABLE TABLET

Prescription Drug - Brand

$12

—

59417011901

VYVANSE 50 MG CHEWABLE TABLET

Prescription Drug - Brand

$12

—

59417012001

VYVANSE 60 MG CHEWABLE TABLET

Prescription Drug - Brand

$12

—

59425

Antepartum care only

Surgery - Maternity

$392

—

59426

Antepartum care only

Surgery - Maternity

$718

—

59430

Care after delivery

Surgery - Maternity

$162

—

59467031830

MITIGARE 0.6 MG CAPSULE

Prescription Drug - Brand

$6

—

59467067901

KLOXXADO 8 MG NASAL SPRAY

Prescription Drug - Brand

$60

—

59467070027

RYALTRIS 665-25 MCG SPRAY

Prescription Drug - Brand

$8

—

59510

Cesarean delivery

Surgery - Maternity

$2,473

—

59514

Cesarean delivery only

Surgery - Maternity

$824

—

59515

Cesarean delivery

Surgery - Maternity

$1,225

—

59525

Remove uterus after cesarean

Surgery - Maternity

$426

—

59528031701

NEPHPLEX RX TABLET

Prescription Drug - Generic

$0

—

59528198801

VITAL-D RX TABLET

Prescription Drug - Generic

$0

—

59610

Vbac delivery

Surgery - Maternity

$2,331

—

59612

Vbac delivery only

Surgery - Maternity

$823

—

59614

Vbac care after delivery

Surgery - Maternity

$1,066

—

59618

Attempted vbac delivery

Surgery - Maternity

$2,500

—

59620

Attempted vbac delivery only

Surgery - Maternity

$852

—

59622

Attempted vbac after care

Surgery - Maternity

$1,263

—

59627000104

AVONEX ADMIN PACK 30 MCG VL

Prescription Drug - Brand

$1,398

—

59627000205

AVONEX PREFILLED SYR 30 MCG

Prescription Drug - Brand

$4,372

—

59627011103

AVONEX 30 MCG VIAL KIT

Prescription Drug - Brand

$1,663

—

59627022205

AVONEX 30 MCG/0.5 ML SYRINGE KIT (4 PACK)

Prescription Drug - Brand

$8,819

—

59627033304

AVONEX PEN 30 MCG/0.5 ML KIT (4 PACK)

Prescription Drug - Brand

$8,827

—

59630057560

FORTAMET ER 1,000 MG TABLET

Prescription Drug - Brand

$27

—

59630063030

ALTOPREV 60 MG TABLET

Prescription Drug - Brand

$25

—

59630070148

ORAPRED ODT 15 MG TABLET

Prescription Drug - Brand

$11

—

59630070248

ORAPRED ODT 30 MG TABLET

Prescription Drug - Brand

$14

—

59630075050

METHYLIN 5 MG/5 ML SOLUTION

Prescription Drug - Brand

$0

—

59630075550

METHYLIN 10 MG/5 ML SOLUTION

Prescription Drug - Brand

$0

—

59651001990

NIACIN ER 750 MG TABLET

Prescription Drug - Generic

$0

—

59651002988

LO-ZUMANDIMINE 3 MG-0.02 MG TB

Prescription Drug - Generic

$0

—

59651003085

ZUMANDIMINE 3 MG-0.03 MG TAB

Prescription Drug - Generic

$0

—

59651013688

EMZAHH 0.35 MG TABLET

Prescription Drug - Generic

$0

—

59651022501

PILOCARPINE HCL 7.5 MG TABLET

Prescription Drug - Generic

$0

—

59651026101

CLOZAPINE ODT 25 MG TABLET

Prescription Drug - Generic

$2

—

59651026201

CLOZAPINE ODT 100 MG TABLET

Prescription Drug - Generic

$5

—

My Cost List