Medical Procedure Costs

78610

Brain flow imaging only

Radiology

$157

—

78630

Cerebrospinal fluid scan

Radiology

$295

—

78635

Csf ventriculography

Radiology

$295

—

78645

Csf shunt evaluation

Radiology

$285

—

78650

Csf leakage imaging

Radiology

$245

—

78660

Nuclear exam of tear flow

Radiology

$133

—

78670005096

LUCEMYRA 0.18 MG TABLET

Prescription Drug - Brand

$23

—

78700

Kidney imaging morphol

Radiology

$153

—

78701

Kidney imaging with flow

Radiology

$203

—

78707

K flow/funct image w/o drug

Radiology

$209

—

78708

K flow/funct image w/drug

Radiology

$172

—

78709

K flow/funct image multiple

Radiology

$326

—

78725

Kidney function study

Radiology

$100

—

78730

Urinary bladder retention

Radiology

$73

—

78740

Ureteral reflux study

Radiology

$221

—

78761

Testicular imaging w/flow

Radiology

$190

—

78800

Rp loclzj tum 1 area 1 d img

Radiology

$232

—

78801

Rp loclzj tum 2+area 1+d img

Radiology

$240

—

78802

Rp loclzj tum whbdy 1 d img

Radiology

$270

—

78803

Rp loclzj tum spect 1 area

Radiology

$336

—

78804

Rp loclzj tum whbdy 2+d img

Radiology

$561

—

78808

Iv inj ra drug dx study

Radiology

$41

—

78816

Pet image w/ct full body

Nuclear Medicine

$178

$1

$785

78830

Rp loclzj tum spect w/ct 1

Radiology

$421

—

78831

Rp loclzj tum spect 2 areas

Radiology

$623

—

78832

Rp loclzj tum spect w/ct 2

Radiology

$791

—

78835

Rp quan meas single area

Radiology

$90

—

79005

Nuclear rx oral admin

Radiology

$132

—

79101

Nuclear rx iv admin

Radiology

$143

—

79200

Nuclear rx intracav admin

Radiology

$131

—

79403

Hematopoietic nuclear tx

Radiology

$157

—

79440

Nuclear rx intra-articular

Radiology

$117

—

80005011714

PRIMIDONE 50 MG TABLET

Prescription Drug - Generic

$0

—

80005011811

PRIMIDONE 250 MG TABLET

Prescription Drug - Generic

$0

—

80005011916

FAMOTIDINE 40 MG/5 ML SUSP

Prescription Drug - Generic

$0

—

80005012625

BALSALAZIDE DISODIUM 750 MG CP

Prescription Drug - Generic

$0

—

80005013022

AMINOCAPROIC ACID 0.25 GRAM/ML

Prescription Drug - Generic

$1

—

80005013109

CLINDAMYCIN PHOS 1% PLEDGET

Prescription Drug - Generic

$0

—

80047

Blood test, basic group of blood chemicals (Calcium, ionized)

Pathology/Laboratory

$14

—

80048

Blood test, basic group of blood chemicals (Calcium, total)

Pathology/Laboratory

$8

—

80051

Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)

Pathology/Laboratory

$7

—

80053

Blood test, comprehensive group of blood chemicals

Pathology/Laboratory

$11

—

80055

Obstetric blood test panel

Pathology/Laboratory

$48

—

80061

Blood test, lipids (cholesterol and triglycerides)

Pathology/Laboratory

$13

—

80069

Kidney function blood test panel

Pathology/Laboratory

$9

—

80074

Acute hepatitis panel

Pathology/Laboratory

$48

—

80076

Liver function blood test panel

Pathology/Laboratory

$8

—

80081

Blood test panel for obstetrics ( cbc, differential wbc count, hepatitis b,

Pathology/Laboratory

$75

—

80143

Measurement of acetaminophen

Pathology/Laboratory

$19

—

80145

Measurement of adalimumab

Pathology/Laboratory

$39

—

My Cost List