Medical Procedure Costs

70165001530

ADZENYS XR-ODT 9.4 MG TABLET

Prescription Drug - Brand

$19

—

70165002030

ADZENYS XR-ODT 12.5 MG TABLET

Prescription Drug - Brand

$19

—

70165002530

ADZENYS XR-ODT 15.7 MG TABLET

Prescription Drug - Brand

$19

—

70165003030

ADZENYS XR-ODT 18.8 MG TABLET

Prescription Drug - Brand

$19

—

70165010030

COTEMPLA XR-ODT 8.6 MG TABLET

Prescription Drug - Brand

$18

—

70165020030

COTEMPLA XR-ODT 17.3 MG TABLET

Prescription Drug - Brand

$18

—

70165030030

COTEMPLA XR-ODT 25.9 MG TABLET

Prescription Drug - Brand

$18

—

70183022131

INPEFA 200 MG TABLET

Prescription Drug - Brand

$20

—

70190

X-ray exam of eye sockets

Radiology

$37

—

70199001730

THALITONE 15 MG TABLET

Prescription Drug - Brand

$4

—

70200

X-ray exam of eye sockets

Radiology

$47

—

70210

X-ray exam of sinuses

Radiology

$32

—

70211070304

COATS ALOE CREME

Prescription Drug - Generic

$0

—

70220

X-ray exam of sinuses

Radiology

$38

—

70240

X-ray exam pituitary saddle

Radiology

$32

—

70250

X-ray exam of skull

Radiology

$36

—

70260

X-ray exam of skull

Radiology

$44

—

70300

X-ray exam of teeth

Radiology

$14

—

70301100102

RAYALDEE ER 30 MCG CAP (SOFT)

Prescription Drug - Brand

$40

—

70301100201

RAYALDEE ER 30 MCG CAP (HARD)

Prescription Drug - Brand

$41

—

70310

X-ray exam of teeth

Radiology

$43

—

70320

Full mouth x-ray of teeth

Radiology

$57

—

70328

X-ray exam of jaw joint

Radiology

$34

—

70330

X-ray exam of jaw joints

Radiology

$53

—

70332

X-ray exam of jaw joint

Radiology

$80

—

70336

Magnetic image jaw joint

Radiology

$259

—

70347020890

ZONTIVITY 2.08 MG TABLET

Prescription Drug - Brand

$11

—

70350

X-ray head for orthodontia

Radiology

$18

—

70355

Panoramic x-ray of jaws

Radiology

$19

—

70360

X-ray exam of neck

Radiology

$31

—

70370

Throat x-ray & fluoroscopy

Radiology

$100

—

70370106001

INGREZZA 60 MG CAPSULE

Prescription Drug - Brand

$283

—

70370108001

INGREZZA 80 MG CAPSULE

Prescription Drug - Brand

$283

—

70370204001

INGREZZA 40 MG CAPSULE

Prescription Drug - Brand

$259

—

70370302502

ONGENTYS 25 MG CAPSULE

Prescription Drug - Brand

$25

—

70370305002

ONGENTYS 50 MG CAPSULE

Prescription Drug - Brand

$25

—

70371

Speech evaluation complex

Radiology

$111

—

70377006911

EVEROLIMUS 0.25 MG TABLET

Prescription Drug - Generic

$2

—

70377007011

EVEROLIMUS 0.5 MG TABLET

Prescription Drug - Generic

$4

—

70377007111

EVEROLIMUS 0.75 MG TABLET

Prescription Drug - Generic

$7

—

70377010311

AMINOCAPROIC ACID 1,000 MG TAB

Prescription Drug - Generic

$8

—

70377011211

EVEROLIMUS 1 MG TABLET

Prescription Drug - Generic

$9

—

70377013812

TRIAMTERENE 50 MG CAPSULE

Prescription Drug - Generic

$7

—

70377013912

TRIAMTERENE 100 MG CAPSULE

Prescription Drug - Generic

$7

—

70380

X-ray exam of salivary gland

Radiology

$37

—

70390

X-ray exam of salivary duct

Radiology

$111

—

70428001112

QBREXZA 2.4% CLOTH

Prescription Drug - Brand

$21

—

70436001404

OLMSRTN-AMLDPN-HYDROCHLOROTHIAZIDE 20-5-12.5

Prescription Drug - Generic

$1

—

70436001504

OLMSRTN-AMLDPN-HYDROCHLOROTHIAZIDE 40-5-12.5

Prescription Drug - Generic

$1

—

70436001604

OLMSRTN-AMLDPN-HYDROCHLOROTHIAZIDE 40-5-25 MG

Prescription Drug - Generic

$1

—

My Cost List