Medical Procedure Costs

74415

Urography nfs drip&/bls w/nf

Radiology

$152

—

74420

Urography rtrgr +-kub

Radiology

$81

—

74425

Urography antegrade rs&i

Radiology

$134

—

74430

Contrast x-ray bladder

Radiology

$42

—

74440

X-ray male genital tract

Radiology

$101

—

74455

X-ray urethra/bladder

Radiology

$106

—

74485

Dilation urtr/urt rs&i

Radiology

$124

—

74676011202

TLANDO 112.5 MG CAPSULE

Prescription Drug - Brand

$7

—

74712

Mri fetal sngl/1st gestation

Radiology

$406

—

74713

Mri fetal ea addl gestation

Radiology

$197

—

74740

X-ray female genital tract

Radiology

$90

—

75557

Cardiac mri for morph

Radiology

$280

—

75559

Cardiac mri w/stress img

Radiology

$380

—

75561

Cardiac mri for morph w/dye

Radiology

$365

—

75563

Card mri w/stress img & dye

Radiology

$430

—

75565

Card mri veloc flow mapping

Radiology

$45

—

75571

Ct hrt w/o dye w/ca test

Radiology

$100

—

75572

Ct hrt w/3d image

Radiology

$229

—

75573

Ct hrt c+ strux cgen hrt ds

Radiology

$309

—

75574

Ct angio hrt w/3d image

Radiology

$326

—

75577

Quan&char c athrosclrtc plaq

Radiology

$1,012

—

75580

N-invas est c ffr sw aly cta

Radiology

$887

—

75600

Contrast exam thoracic aorta

Radiology

$177

—

75605

Contrast exam thoracic aorta

Radiology

$121

—

75625

Contrast exam abdominl aorta

Radiology

$125

—

75630

X-ray aorta leg arteries

Radiology

$156

—

75635

Ct angio abdominal arteries

Radiology

$411

—

75705

Artery x-rays spine

Radiology

$291

—

75710

Artery x-rays arm/leg

Radiology

$149

—

75716

Artery x-rays arms/legs

Radiology

$163

—

75726

Artery x-rays abdomen

Radiology

$168

—

75731

Artery x-rays adrenal gland

Radiology

$151

—

75733

Artery x-rays adrenals

Radiology

$175

—

75736

Artery x-rays pelvis

Radiology

$143

—

75741

Artery x-rays lung

Radiology

$128

—

75743

Artery x-rays lungs

Radiology

$146

—

75746

Artery x-rays lung

Radiology

$134

—

75756

Artery x-rays chest

Radiology

$167

—

75774

Artery x-ray each vessel

Radiology

$95

—

75788011504

BREXAFEMME 150 MG TABLET

Prescription Drug - Brand

$131

—

75809

Nonvascular shunt x-ray

Radiology

$85

—

75820

Vein x-ray arm/leg

Radiology

$107

—

75822

Vein x-ray arms/legs

Radiology

$133

—

75825

Vein x-ray trunk

Radiology

$114

—

75826011410

PHENAZOPYRIDINE 100 MG TAB

Prescription Drug - Generic

$0

—

75826011510

PHENAZOPYRIDINE 200 MG TAB

Prescription Drug - Generic

$0

—

75826011810

PHENOHYTRO TABLET

Prescription Drug - Generic

$1

—

75826012310

DEXTROAMPHETAMINE 10 MG TAB

Prescription Drug - Generic

$0

—

75826012430

DEXTROAMPHETAMINE 15 MG TAB

Prescription Drug - Generic

$5

—

75826012530

DEXTROAMPHETAMINE 20 MG TAB

Prescription Drug - Generic

$6

—

My Cost List