Medical Procedure Costs

73352069810

EVEXITHROID 90 MG TABLET

Prescription Drug - Generic

$1

—

73352069910

EVEXITHROID 120 MG TABLET

Prescription Drug - Generic

$1

—

73352082501

TRIDACAINE 5% PATCH

Prescription Drug - Generic

$2

—

73352083001

TRIDACAINE II 5% PATCH

Prescription Drug - Generic

$2

—

73352083501

TRIDACAINE III 5% PATCH

Prescription Drug - Generic

$2

—

73352084530

TRIDACAINE XL 5% PATCH

Prescription Drug - Generic

$2

—

73358024101

CURAE 1.5 MG TABLET

Prescription Drug - Generic

$7

—

73473030060

CLINDAMYCIN PH 1% GEL

Prescription Drug - Generic

$0

—

73473030275

CLINDAMYCIN PHOSPHATE 1% GEL

Prescription Drug - Generic

$4

—

73473030370

METRONIDAZOLE VAGINAL 0.75% GL

Prescription Drug - Generic

$0

—

73473030660

CLINDA-TRETINOIN 1.2%-0.025%

Prescription Drug - Generic

$3

—

73473030850

ESTRADIOL 0.06% 1.25G GEL PUMP

Prescription Drug - Generic

$4

—

73473030930

TAZAROTENE 0.05% GEL

Prescription Drug - Generic

$7

—

73473031030

TAZAROTENE 0.1% GEL

Prescription Drug - Generic

$8

—

73473080010

DICYCLOMINE 10 MG CAPSULE

Prescription Drug - Generic

$0

—

73473090105

NEOMYCIN 500 MG TABLET

Prescription Drug - Generic

$1

—

73473090210

DICYCLOMINE 20 MG TABLET

Prescription Drug - Generic

$0

—

73473090330

MOXIFLOXACIN HCL 400 MG TABLET

Prescription Drug - Generic

$2

—

73501

X-ray exam hip uni 1 view

Radiology

$34

—

73502

X-ray exam hip uni 2-3 views

Radiology

$49

—

73503

X-ray exam hip uni 4/> views

Radiology

$63

—

73515012330

CYCLOSET 0.8 MG TABLET

Prescription Drug - Brand

$5

—

73521

X-ray exam hips bi 2 views

Radiology

$42

—

73521003002

TYRVAYA 0.03 MG NASAL SPRAY

Prescription Drug - Brand

$80

—

73522

X-ray exam hips bi 3-4 views

Radiology

$54

—

73523

X-ray exam hips bi 5/> views

Radiology

$61

—

73525

Contrast x-ray of hip

Radiology

$133

—

73551

X-ray exam of femur 1

Radiology

$29

—

73552

X-ray exam of femur 2/>

Radiology

$36

—

73560

X-ray exam of knee 1 or 2

Radiology

$34

—

73562

X-ray exam of knee 3

Radiology

$42

—

73562010410

VIOKACE 10,440-39,150 UNIT TAB

Prescription Drug - Brand

$4

—

73562011001

ZENPEP DR 10,000 UNIT CAPSULE

Prescription Drug - Brand

$4

—

73562011101

ZENPEP DR 15,000 UNIT CAPSULE

Prescription Drug - Brand

$6

—

73562011201

ZENPEP DR 20,000 UNIT CAPSULE

Prescription Drug - Brand

$8

—

73562011301

ZENPEP DR 3,000 UNIT CAPSULE

Prescription Drug - Brand

$2

—

73562011401

ZENPEP DR 40,000 UNIT CAPSULE

Prescription Drug - Brand

$16

—

73562011501

ZENPEP DR 5,000 UNIT CAPSULE

Prescription Drug - Brand

$2

—

73562011601

ZENPEP DR 25,000 UNIT CAPSULE

Prescription Drug - Brand

$10

—

73562011701

ZENPEP DR 60,000 UNIT CAPSULE

Prescription Drug - Brand

$24

—

73562020810

VIOKACE 20,880-78,300 UNITS TB

Prescription Drug - Brand

$8

—

73564

X-ray exam knee 4 or more

Radiology

$49

—

73565

X-ray exam of knees

Radiology

$42

—

73580

Contrast x-ray of knee joint

Radiology

$117

—

73590

X-ray exam of lower leg

Radiology

$31

—

73592

X-ray exam of leg infant

Radiology

$31

—

73600

X-ray exam of ankle

Radiology

$32

—

73610

X-ray exam of ankle

Radiology

$37

—

73615

Contrast x-ray of ankle

Radiology

$133

—

73620

X-ray exam of foot

Radiology

$29

—

My Cost List