Medical Procedure Costs

78140

Red cell sequestration

Radiology

$110

—

78185

Spleen imaging

Radiology

$154

—

78191

Platelet survival study

Radiology

$127

—

78195

Lymph system imaging

Radiology

$312

—

78201

Liver imaging static only

Radiology

$172

—

78202

Liver imaging with vasc flow

Radiology

$192

—

78206011101

ASMANEX HFA 50 MCG INHALER

Prescription Drug - Brand

$7

—

78206011201

ASMANEX HFA 100 MCG INHALER

Prescription Drug - Brand

$7

—

78206011301

ASMANEX HFA 200 MCG INHALER

Prescription Drug - Brand

$9

—

78206011401

ASMANEX TWISTHALR 220 MCG #120

Prescription Drug - Brand

$162

—

78206011402

ASMANEX TWISTHALER 220 MCG #60

Prescription Drug - Brand

$113

—

78206011403

ASMANEX TWISTHALER 220 MCG #14

Prescription Drug - Brand

$37

—

78206011404

ASMANEX TWISTHALER 220 MCG #30

Prescription Drug - Brand

$96

—

78206011501

ASMANEX TWISTHALER 110 MCG #30

Prescription Drug - Brand

$89

—

78206011801

CELESTONE SOLUSPAN 30 MG/5 ML

Prescription Drug - Brand

$9

—

78206012001

CLARINEX-D 12 HR 2.5-120 MG TB

Prescription Drug - Brand

$6

—

78206012101

COZAAR 25 MG TABLET

Prescription Drug - Brand

$3

—

78206012202

COZAAR 50 MG TABLET

Prescription Drug - Brand

$5

—

78206012302

COZAAR 100 MG TABLET

Prescription Drug - Brand

$6

—

78206012501

DULERA 50 MCG-5 MCG INHALER

Prescription Drug - Brand

$25

—

78206012602

DULERA 200 MCG-5 MCG INHALER

Prescription Drug - Brand

$25

—

78206012702

DULERA 100 MCG-5 MCG INHALER

Prescription Drug - Brand

$25

—

78206013501

FOSAMAX 70 MG TABLET

Prescription Drug - Brand

$39

—

78206013601

FOSAMAX PLUS D 70 MG-5600 UNIT

Prescription Drug - Brand

$52

—

78206013701

FOSAMAX PLUS D 70 MG-2800 UNIT

Prescription Drug - Brand

$53

—

78206013802

GANIRELIX ACET 250 MCG/0.5 ML

Prescription Drug - Generic

$62

—

78206013902

HYZAAR 50-12.5 TABLET

Prescription Drug - Brand

$5

—

78206014002

HYZAAR 100-12.5 TABLET

Prescription Drug - Brand

$7

—

78206014102

HYZAAR 100-25 TABLET

Prescription Drug - Brand

$7

—

78206014299

MAXALT 10 MG TABLET

Prescription Drug - Brand

$44

—

78206014399

MAXALT MLT 10 MG TABLET

Prescription Drug - Brand

$44

—

78206014603

NUVARING VAGINAL RING

Prescription Drug - Brand

$156

—

78206015099

PREGNYL 10,000 UNIT VIAL

Prescription Drug - Brand

$172

—

78206015202

PROPECIA 1 MG TABLET

Prescription Drug - Brand

$4

—

78206015302

PROSCAR 5 MG TABLET

Prescription Drug - Brand

$6

—

78206016001

REMERON 15 MG TABLET

Prescription Drug - Brand

$6

—

78206016101

REMERON 30 MG TABLET

Prescription Drug - Brand

$7

—

78206017202

SINGULAIR 10 MG TABLET

Prescription Drug - Brand

$9

—

78206017301

SINGULAIR 5 MG TABLET CHEW

Prescription Drug - Brand

$9

—

78206017502

VYTORIN 10-20 MG TABLET

Prescription Drug - Brand

$14

—

78206017602

VYTORIN 10-40 MG TABLET

Prescription Drug - Brand

$14

—

78206017702

VYTORIN 10-80 MG TABLET

Prescription Drug - Brand

$13

—

78206017801

ZETIA 10 MG TABLET

Prescription Drug - Brand

$14

—

78206018102

ZOCOR 20 MG TABLET

Prescription Drug - Brand

$10

—

78206018202

ZOCOR 40 MG TABLET

Prescription Drug - Brand

$10

—

78206018401

HADLIMA PUSHTOUCH 40 MG/0.8 ML

Prescription Drug - Brand

$632

—

78206018601

HADLIMA(CF) 40 MG/0.4 ML SYRINGE

Prescription Drug - Brand

$1,259

—

78206018701

HADLIMA(CF) PUSHTOUCH 40 MG/0.4 ML

Prescription Drug - Brand

$1,261

—

78206018801

CLARINEX 5 MG TABLET

Prescription Drug - Brand

$8

—

78206018999

XACIATO 2% VAGINAL GEL

Prescription Drug - Brand

$19

—

My Cost List