Medical Procedure Costs

00051846231

ANDROGEL 1.62%(1.25G) GEL PCKT

Prescription Drug - Brand

$16

—

00051846233

ANDROGEL 1.62% GEL PUMP

Prescription Drug - Brand

$8

—

00051848888

ANDROGEL 1% GEL PUMP

Prescription Drug - Brand

$3

—

00052010930

REMERON 45 MG TABLET

Prescription Drug - Brand

$5

—

00052011806

SAPHRIS 5 MG TABLET SUBLINGUAL

Prescription Drug - Brand

$12

—

00052031510

PREGNYL 10,000 UNITS VIAL

Prescription Drug - Brand

$102

—

00052060202

BCG (TICE STRAIN) VIAL

Prescription Drug - Brand

$182

—

00053687100

STIMATE 1.5 MG/ML NASAL SPRAY

Prescription Drug - Brand

$289

—

00054005746

DIGOXIN 50 MCG/ML SOLUTION

Prescription Drug - Generic

$1

—

00054022849

MELOXICAM 7.5 MG/5 ML SUSP

Prescription Drug - Generic

$1

—

00054024324

CODEINE SULFATE 15 MG TABLET

Prescription Drug - Generic

$1

—

00054024525

CODEINE SULFATE 60 MG TABLET

Prescription Drug - Generic

$1

—

00054026225

CALCIUM GLUCONATE 500 MG TAB

Prescription Drug - Generic

$0

—

00054038663

HYDROMORPHONE 1 MG/ML SOLUTION

Prescription Drug - Generic

$0

—

00054317644

DEXAMETHASONE INTENSOL 1 MG/ML

Prescription Drug - Generic

$1

—

00054317763

DEXAMETHASONE 0.5 MG/5 ML LIQ

Prescription Drug - Generic

$0

—

00054318544

DIAZEPAM 5 MG/ML ORAL CONC

Prescription Drug - Generic

$1

—

00054318863

DIAZEPAM 5 MG/5 ML SOLUTION

Prescription Drug - Generic

$0

—

00054319446

DIPHENOXYLATE-ATROPINE 2.5-0.025 MG/5 ML LIQUID

Prescription Drug - Generic

$0

—

00054329450

FUROSEMIDE 10 MG/ML SOLUTION

Prescription Drug - Generic

$0

—

00054353244

LORAZEPAM INTENSOL 2 MG/ML

Prescription Drug - Generic

$1

—

00054354563

MEPERIDINE 50 MG/5 ML SOLUTION

Prescription Drug - Generic

$0

—

00054355344

METHADONE INTENSOL 10 MG/ML

Prescription Drug - Generic

$1

—

00054368663

ROXICET 5-325 ORAL SOLUTION

Prescription Drug - Generic

$0

—

00054372144

PREDNISONE INTENSOL 5 MG/ML

Prescription Drug - Generic

$3

—

00054372263

PREDNISONE 5 MG/5 ML SOLUTION

Prescription Drug - Generic

$1

—

00054372763

PROPRANOLOL 20 MG/5 ML SOLN

Prescription Drug - Generic

$0

—

00054373063

PROPRANOLOL 40 MG/5 ML SOLN

Prescription Drug - Generic

$0

—

00054412025

CALCIUM CARB 500 (1,250) MG TB

Prescription Drug - Generic

$0

—

00054413025

CYCLOPHOSPHAMIDE 50 MG TABLET

Prescription Drug - Generic

$3

—

00054472125

PROPANTHELINE 15 MG TABLET

Prescription Drug - Generic

$1

—

00054812025

CALCIUM CARBONATE 1.25 GM TAB

Prescription Drug - Generic

$0

—

00054859511

MEPERIDINE 50 MG TABLET

Prescription Drug - Generic

$1

—

00054865024

ROXICET 5-325 TABLET

Prescription Drug - Generic

$0

—

00056016875

COUMADIN 4 MG TABLET

Prescription Drug - Brand

$2

—

00056016901

COUMADIN 1 MG TABLET

Prescription Drug - Brand

$2

—

00056017001

COUMADIN 2 MG TABLET

Prescription Drug - Brand

$2

—

00056017270

COUMADIN 5 MG TABLET

Prescription Drug - Brand

$2

—

00056017370

COUMADIN 7.5 MG TABLET

Prescription Drug - Brand

$3

—

00056017470

COUMADIN 10 MG TABLET

Prescription Drug - Brand

$3

—

00056017675

COUMADIN 2.5 MG TABLET

Prescription Drug - Brand

$2

—

00056018875

COUMADIN 3 MG TABLET

Prescription Drug - Brand

$2

—

00056018970

COUMADIN 6 MG TABLET

Prescription Drug - Brand

$3

—

00056047492

SUSTIVA 200 MG CAPSULE

Prescription Drug - Brand

$11

—

00056051030

SUSTIVA 600 MG TABLET

Prescription Drug - Brand

$32

—

0005U

Test for detecting genes associated with prostate cancer in urine

Pathology/Laboratory

$760

—

00062019003

RETIN-A MICRO 0.1% GEL

Prescription Drug - Brand

$14

—

00062019011

RETIN-A MICRO PUMP 0.1% GEL

Prescription Drug - Brand

$16

—

00062020403

RETIN-A MICRO 0.04% GEL

Prescription Drug - Brand

$14

—

00062020411

RETIN-A MICRO PUMP 0.04% GEL

Prescription Drug - Brand

$15

—

My Cost List