Medical Procedure Costs

75834031201

NIVA THYROID 60 MG TABLET

Prescription Drug - Generic

$1

—

75834031301

NIVA THYROID 90 MG TABLET

Prescription Drug - Generic

$1

—

75834031401

NIVA THYROID 120 MG TABLET

Prescription Drug - Generic

$1

—

75834032001

VERAPAMIL ER 120 MG TABLET

Prescription Drug - Generic

$0

—

75834032401

METHYLPHENIDATE 5 MG TABLET

Prescription Drug - Generic

$0

—

75834032501

METHYLPHENIDATE 10 MG TABLET

Prescription Drug - Generic

$0

—

75834032601

METHYLPHENIDATE 20 MG TABLET

Prescription Drug - Generic

$0

—

75834032701

DEXMETHYLPHENIDATE 5 MG TAB

Prescription Drug - Generic

$0

—

75834032801

DEXMETHYLPHENIDATE 10 MG TAB

Prescription Drug - Generic

$0

—

75834033330

LIDOCAINE ANORECTAL 5% CREAM

Prescription Drug - Generic

$0

—

75840

Vein x-ray adrenal gland

Radiology

$126

—

75854030530

FERIVA MULTIPHASE CAPSULE

Prescription Drug - Brand

$4

—

75854030930

PRENATE ENHANCE SOFTGEL

Prescription Drug - Brand

$4

—

75854031030

FERIVAFA CAPSULE

Prescription Drug - Brand

$5

—

75854031230

PRENATE DHA SOFTGEL

Prescription Drug - Brand

$13

—

75854031330

PRENATE ESSENTIAL SOFTGEL

Prescription Drug - Brand

$5

—

75854031430

PRENATE ELITE TABLET

Prescription Drug - Brand

$5

—

75854031530

PRENATE MINI SOFTGEL

Prescription Drug - Brand

$13

—

75854031630

PRENATE PIXIE SOFTGEL

Prescription Drug - Brand

$13

—

75854034260

NICOMIDE TABLET

Prescription Drug - Brand

$3

—

75854060228

BALCOLTRA TABLET

Prescription Drug - Brand

$10

—

75854070101

DHIVY 25-100 MG TABLET

Prescription Drug - Brand

$4

—

75860

Vein x-ray neck

Radiology

$130

—

75870

Vein x-ray skull

Radiology

$184

—

75872

Vein x-ray skull epidural

Radiology

$126

—

75880

Vein x-ray eye socket

Radiology

$105

—

75885

Vein x-ray liver w/hemodynam

Radiology

$135

—

75887

Vein x-ray liver w/o hemodyn

Radiology

$136

—

75889

Vein x-ray liver w/hemodynam

Radiology

$122

—

75891

Vein x-ray liver

Radiology

$123

—

75893

Venous sampling by catheter

Radiology

$111

—

75894

X-rays transcath therapy

Radiology

$317

—

75898

Follow-up angiography

Radiology

$273

—

75901

Remove cva device obstruct

Radiology

$228

—

75902

Remove cva lumen obstruct

Radiology

$86

—

75907000101

LIOTHYRONINE SOD 25 MCG TAB

Prescription Drug - Generic

$0

—

75907000401

LIOTHYRONINE SOD 50 MCG TAB

Prescription Drug - Generic

$0

—

75907000530

AMIODARONE HCL 100 MG TABLET

Prescription Drug - Generic

$0

—

75907000660

AMIODARONE HCL 200 MG TABLET

Prescription Drug - Generic

$0

—

75907000901

BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50-325-40 MG CAPSULE

Prescription Drug - Generic

$2

—

75907002010

CARBIDOPA-LEVODOPA 25-100 TAB

Prescription Drug - Generic

$0

—

75907002105

CARBIDOPA-LEVODOPA 25-250 TAB

Prescription Drug - Generic

$0

—

75907002201

CARBIDOPA-LEVODOPA 10-100 TAB

Prescription Drug - Generic

$0

—

75907002348

CLONIDINE 0.1 MG/DAY PATCH

Prescription Drug - Generic

$7

—

75907002448

CLONIDINE 0.2 MG/DAY PATCH

Prescription Drug - Generic

$9

—

75907002548

CLONIDINE 0.3 MG/DAY PATCH

Prescription Drug - Generic

$12

—

75907002601

DISOPYRAMIDE 150 MG CAPSULE

Prescription Drug - Generic

$2

—

75907002701

DISOPYRAMIDE 100 MG CAPSULE

Prescription Drug - Generic

$1

—

75907002801

ESTAZOLAM 1 MG TABLET

Prescription Drug - Generic

$1

—

75907002901

ESTAZOLAM 2 MG TABLET

Prescription Drug - Generic

$1

—

My Cost List