Medical Procedure Costs

72147

Mri chest spine w/dye

Radiology

$271

—

72148

Mri lumbar spine w/o dye

Radiology

$192

—

72149

Mri lumbar spine w/dye

Radiology

$270

—

72156

Mri neck spine w/o & w/dye

Radiology

$318

—

72157

Mri chest spine w/o & w/dye

Radiology

$319

—

72158

Mri lumbar spine w/o & w/dye

Radiology

$318

—

72159

Mr angio spine w/o&w/dye

Radiology

$337

—

72170

X-ray exam of pelvis

Radiology

$28

—

72190

X-ray exam of pelvis

Radiology

$43

—

72191

Ct angiograph pelv w/o&w/dye

Radiology

$304

—

72192

Ct pelvis w/o dye

Radiology

$133

—

72193

Ct pelvis w/dye

Radiology

$226

—

72194

Ct pelvis w/o & w/dye

Radiology

$251

—

72195

Mri pelvis w/o dye

Radiology

$227

—

72196

Mri pelvis w/dye

Radiology

$268

—

72197

Mri pelvis w/o & w/dye

Radiology

$334

—

72198

Mr angio pelvis w/o & w/dye

Radiology

$336

—

72200

X-ray exam si joints

Radiology

$34

—

72202

X-ray exam si joints 3/> vws

Radiology

$39

—

72205000891

TRIENTINE HCL 250 MG CAPSULE

Prescription Drug - Generic

$3

—

72205000930

SILODOSIN 4 MG CAPSULE

Prescription Drug - Generic

$0

—

72205001090

SILODOSIN 8 MG CAPSULE

Prescription Drug - Generic

$0

—

72205002090

SOLIFENACIN 5 MG TABLET

Prescription Drug - Generic

$0

—

72205002190

SOLIFENACIN 10 MG TABLET

Prescription Drug - Generic

$0

—

72205003772

LEVETIRACETAM 100 MG/ML SOLN

Prescription Drug - Generic

$0

—

72205004791

CLOBAZAM 10 MG TABLET

Prescription Drug - Generic

$0

—

72205004891

CLOBAZAM 20 MG TABLET

Prescription Drug - Generic

$0

—

72205004930

AMINOCAPROIC ACID 500 MG TAB

Prescription Drug - Generic

$3

—

72205005030

TOREMIFENE CITRATE 60 MG TAB

Prescription Drug - Generic

$24

—

72205005108

ALBENDAZOLE 200 MG TABLET

Prescription Drug - Generic

$4

—

72205005976

SILDENAFIL 10 MG/ML ORAL SUSP

Prescription Drug - Generic

$0

—

72205008430

TIAGABINE HCL 2 MG TABLET

Prescription Drug - Generic

$2

—

72205008530

TIAGABINE HCL 4 MG TABLET

Prescription Drug - Generic

$2

—

72205008630

TIAGABINE HCL 12 MG TABLET

Prescription Drug - Generic

$6

—

72205008730

TIAGABINE HCL 16 MG TABLET

Prescription Drug - Generic

$6

—

72205009872

PYRIDOSTIGMINE 60 MG/5 ML SOLN

Prescription Drug - Generic

$1

—

72205010001

FLUPHENAZINE DEC 125 MG/5 ML

Prescription Drug - Generic

$10

—

72205010491

CHLORPROMAZINE 25 MG TABLET

Prescription Drug - Generic

$0

—

72205010591

CHLORPROMAZINE 50 MG TABLET

Prescription Drug - Generic

$0

—

72205010691

CHLORPROMAZINE 100 MG TABLET

Prescription Drug - Generic

$1

—

72205010791

CHLORPROMAZINE 200 MG TABLET

Prescription Drug - Generic

$1

—

72205013011

TOLVAPTAN 15 MG TABLET

Prescription Drug - Generic

$21

—

72205013111

TOLVAPTAN 30 MG TABLET

Prescription Drug - Generic

$73

—

72205013291

LISDEXAMFETAMINE 10 MG TB CHEW

Prescription Drug - Generic

$5

—

72205013391

LISDEXAMFETAMINE 20 MG TB CHEW

Prescription Drug - Generic

$5

—

72205013491

LISDEXAMFETAMINE 30 MG TB CHEW

Prescription Drug - Generic

$5

—

72205013591

LISDEXAMFETAMINE 40 MG TB CHEW

Prescription Drug - Generic

$5

—

72205013691

LISDEXAMFETAMINE 50 MG TB CHEW

Prescription Drug - Generic

$5

—

72205013791

LISDEXAMFETAMINE 60 MG TB CHEW

Prescription Drug - Generic

$5

—

72205014699

FAMOTIDINE 40 MG TABLET

Prescription Drug - Generic

$0

—

My Cost List