Medical Procedure Costs

70954085220

LEVOFLOXACIN 25 MG/ML SOLUTION

Prescription Drug - Generic

$2

—

70954087210

DEXAMETHASONE 0.5 MG/5 ML ELX

Prescription Drug - Generic

$0

—

70954087910

ANAGRELIDE HCL 0.5 MG CAPSULE

Prescription Drug - Generic

$1

—

70954088110

ANAGRELIDE HCL 1 MG CAPSULE

Prescription Drug - Generic

$2

—

70954089620

MEGESTROL ACET 40 MG/ML SUSP

Prescription Drug - Generic

$0

—

70954092510

NAPROXEN DR 375 MG TABLET

Prescription Drug - Generic

$2

—

70954093410

NITAZOXANIDE 500 MG TABLET

Prescription Drug - Generic

$88

—

70954097820

BROMOCRIPTINE 2.5 MG TABLET

Prescription Drug - Generic

$2

—

71045

X-ray exam chest 1 view

Radiology

$25

—

71046

X-ray exam chest 2 views

Radiology

$33

—

71047

X-ray exam chest 3 views

Radiology

$41

—

71048

X-ray exam chest 4+ views

Radiology

$45

—

71085008130

CLEMSZA 2.68 MG TABLET

Prescription Drug - Generic

$3

—

71085008230

LURBIRO 100 MG TABLET

Prescription Drug - Generic

$3

—

71093013502

QUETIAPINE ER 50 MG TABLET

Prescription Drug - Generic

$0

—

71093013602

QUETIAPINE ER 150 MG TABLET

Prescription Drug - Generic

$0

—

71093013702

QUETIAPINE ER 200 MG TABLET

Prescription Drug - Generic

$0

—

71093013802

QUETIAPINE ER 300 MG TABLET

Prescription Drug - Generic

$0

—

71093013902

QUETIAPINE ER 400 MG TABLET

Prescription Drug - Generic

$0

—

71093014311

SERTRALINE 20 MG/ML ORAL CONC

Prescription Drug - Generic

$0

—

71093015506

ZOLPIDEM TARTRATE 5 MG TABLET

Prescription Drug - Generic

$0

—

71093015606

ZOLPIDEM TARTRATE 10 MG TABLET

Prescription Drug - Generic

$0

—

71100

X-ray exam ribs uni 2 views

Radiology

$36

—

71101

X-ray exam unilat ribs/chest

Radiology

$42

—

71110

X-ray exam ribs bil 3 views

Radiology

$43

—

71111

X-ray exam ribs/chest4/> vws

Radiology

$51

—

71120

X-ray exam breastbone 2/>vws

Radiology

$33

—

71130

X-ray strenoclavic jt 3/>vws

Radiology

$41

—

71143037501

XHANCE 93 MCG EXHALATION DELIVERY NASAL SPRAY

Prescription Drug - Brand

$41

—

71250

Ct thorax dx c-

Radiology

$133

—

71260

Ct thorax dx c+

Radiology

$167

—

71270

Ct thorax dx c-/c+

Radiology

$196

—

71271

Ct thorax lung cancer scr c-

Radiology

$136

—

71275

Ct angiography chest

Radiology

$281

—

71288000920

CEFEPIME HCL 2 GRAM VIAL

Prescription Drug - Generic

$5

—

71288002211

VANCOMYCIN 500 MG VIAL

Prescription Drug - Generic

$2

—

71288010610

BLEOMYCIN SULFATE 15 UNIT VIAL

Prescription Drug - Generic

$25

—

71288011450

GEMCITABINE HCL 1 GRAM VIAL

Prescription Drug - Generic

$20

—

71288030111

CYANOCOBALAMIN 10,000 MCG/10 ML

Prescription Drug - Generic

$1

—

71288030230

CYANOCOBALAMIN 30,000 MCG/30 ML

Prescription Drug - Generic

$1

—

71288040581

HEPARIN SODIUM 5,000 UNIT/0.5 ML SYRINGE

Prescription Drug - Generic

$6

—

71288042691

ENOXAPARIN 300 MG/3 ML VIAL

Prescription Drug - Generic

$11

—

71288045002

HEPARIN SOD 5,000 UNIT/ML VIAL

Prescription Drug - Generic

$1

—

71288045102

HEPARIN SOD 10,000 UNIT/ML VL

Prescription Drug - Generic

$2

—

71288050202

HALOPERIDOL DEC 50 MG/ML VIAL

Prescription Drug - Generic

$7

—

71288050405

HALOPERIDOL DEC 500 MG/5 ML VL

Prescription Drug - Generic

$13

—

71288056384

LIRAGLUTIDE 3-PAK 18 MG/3 ML

Prescription Drug - Generic

$39

—

71288056385

LIRAGLUTIDE 2-PAK 18 MG/3 ML

Prescription Drug - Generic

$44

—

71288072352

BUPIVACAINE 0.25% VIAL

Prescription Drug - Generic

$0

—

71288072652

BUPIVACAINE 0.5% VIAL

Prescription Drug - Generic

$0

—

My Cost List