Medical Procedure Costs

60846080101

UNITHROID 25 MCG TABLET

Prescription Drug - Brand

$4

—

60846080201

UNITHROID 50 MCG TABLET

Prescription Drug - Brand

$4

—

60846080301

UNITHROID 75 MCG TABLET

Prescription Drug - Brand

$4

—

60846080401

UNITHROID 88 MCG TABLET

Prescription Drug - Brand

$4

—

60846080501

UNITHROID 100 MCG TABLET

Prescription Drug - Brand

$4

—

60846080601

UNITHROID 112 MCG TABLET

Prescription Drug - Brand

$4

—

60846080701

UNITHROID 125 MCG TABLET

Prescription Drug - Brand

$4

—

60846080801

UNITHROID 137 MCG TABLET

Prescription Drug - Brand

$4

—

60846080901

UNITHROID 150 MCG TABLET

Prescription Drug - Brand

$4

—

60846081001

UNITHROID 175 MCG TABLET

Prescription Drug - Brand

$4

—

60846081101

UNITHROID 200 MCG TABLET

Prescription Drug - Brand

$4

—

60951031070

ENDODAN 4.8355-325 MG TABLET

Prescription Drug - Generic

$1

—

60951060285

ENDOCET 5-325 MG TABLET

Prescription Drug - Generic

$0

—

60951070070

ENDOCET 7.5-325 MG TABLET

Prescription Drug - Generic

$0

—

60951070170

ENDOCET 2.5-325 MG TABLET

Prescription Drug - Generic

$1

—

60951071270

ENDOCET 10-325 MG TABLET

Prescription Drug - Generic

$0

—

60951079670

ENDOCET 7.5-500 MG TABLET

Prescription Drug - Generic

$0

—

60951079770

ENDOCET 10-650 MG TABLET

Prescription Drug - Generic

$0

—

60977000101

PHENERGAN 25 MG/ML AMPUL

Prescription Drug - Generic

$1

—

60977000202

PHENERGAN 50 MG/ML AMPUL

Prescription Drug - Generic

$2

—

61000

Remove cranial cavity fluid

Surgery - Nervous

$111

—

61001

Remove cranial cavity fluid

Surgery - Nervous

$106

—

61020

Remove brain cavity fluid

Surgery - Nervous

$99

—

61026

Injection into brain canal

Surgery - Nervous

$105

—

61050

Remove brain canal fluid

Surgery - Nervous

$69

—

61055

Injection into brain canal

Surgery - Nervous

$99

—

61070

Brain canal shunt procedure

Surgery - Nervous

$51

—

61105

Tdh sdrl/ventr pnxr

Surgery - Nervous

$498

—

61107

Tdh pnxr implt ventr cath

Surgery - Nervous

$288

—

61108

Tdh pnxr evac&/drg sdrl hmta

Surgery - Nervous

$929

—

61120

Burr hole for ventr puncture

Surgery - Nervous

$774

—

61140

Burr hole/treph bx brain/les

Surgery - Nervous

$1,268

—

61150

Bur hol/trph drg brn abs/cst

Surgery - Nervous

$1,336

—

61151

Burr hole/treph sbsq tapping

Surgery - Nervous

$998

—

61154

Burr hole w/evac&/drg hmtma

Surgery - Nervous

$1,287

—

61156

Burr hol aspir hmtm/cst icer

Surgery - Nervous

$1,224

—

61210

Burr hole implt ventr cath

Surgery - Nervous

$336

—

61215

Ins subq rsvr pmp/nfs sys

Surgery - Nervous

$557

—

61250

Burr hole/treph sttl expl

Surgery - Nervous

$883

—

61253

Burr hole treph ittl uni/bi

Surgery - Nervous

$998

—

61269009475

MINOXIDIL 5% SOLUTION

Prescription Drug - Generic

$0

—

61269015501

MULTIVIT-FLUOR 0.25 MG TAB CHW

Prescription Drug - Generic

$0

—

61269015601

MULTIVIT-FLUOR 0.5 MG TAB CHEW

Prescription Drug - Generic

$0

—

61269015701

MULTIVIT-FLUORIDE 1 MG TAB CHW

Prescription Drug - Generic

$0

—

61269016150

MULTIVIT-FLUOR 0.25 MG/ML DROP

Prescription Drug - Generic

$0

—

61269016250

MULTIVIT-FLUOR 0.5 MG/ML DROP

Prescription Drug - Generic

$0

—

61269016350

MULTIVIT-IRON-FLUOR 0.25 MG/ML

Prescription Drug - Generic

$0

—

61269016450

VIT A,C,D-FLUORIDE 0.25 MG/ML

Prescription Drug - Generic

$0

—

61269016550

SODIUM FLUORIDE 0.5 MG/ML DROP

Prescription Drug - Generic

$0

—

61269032610

FABB TABLET

Prescription Drug - Generic

$0

—

My Cost List