Medical Procedure Costs

45802036665

TESTOSTERONE 1.62% (2.5 G) PKT

Prescription Drug - Generic

$2

—

45802039504

VITAMIN A & D OINTMENT

Prescription Drug - Generic

$0

—

45802039601

GYNAZOLE 1 2% CREAM

Prescription Drug - Brand

$23

—

45802040049

CICLOPIROX 0.77% TOPICAL SUSP

Prescription Drug - Generic

$1

—

45802040265

ALOGLIPTIN-PIOGLIT 25-30 MG TB

Prescription Drug - Generic

$6

—

45802041059

NASAL SPRAY 0.05%

Prescription Drug - Generic

$0

—

45802043262

PSEUDOEPHEDRINE 30 MG TABLET

Prescription Drug - Generic

$0

—

45802043321

DEXTROMETHORPHAN ER 30 MG/5 ML

Prescription Drug - Generic

$0

—

45802044075

PENCICLOVIR 1% CREAM

Prescription Drug - Generic

$65

—

45802044102

FLUTICASONE PROP 0.05% LOTION

Prescription Drug - Generic

$3

—

45802045384

ADAPALENE 0.1% CREAM

Prescription Drug - Generic

$2

—

45802049184

CYANOCOBALAMIN 500 MCG SPRAY

Prescription Drug - Generic

$124

—

45802062786

BUDESONIDE 2 MG RECTAL FOAM

Prescription Drug - Generic

$9

—

45802063733

CLOBETASOL EMOLLNT 0.05% FOAM

Prescription Drug - Generic

$2

—

45802070111

TOLNAFTATE 1% SOLUTION

Prescription Drug - Generic

$0

—

45802070696

TAZAROTENE 0.05% CREAM

Prescription Drug - Generic

$11

—

45802071708

TERCONAZOLE 80 MG SUPPOSITORY

Prescription Drug - Generic

$20

—

45802073033

ACETAMINOPHEN 650 MG SUPPOS

Prescription Drug - Generic

$0

—

45802073233

ACETAMINOPHEN 120 MG SUPPOS

Prescription Drug - Generic

$0

—

45802075830

PROMETHAZINE 12.5 MG SUPPOS

Prescription Drug - Generic

$2

—

45802075930

PROMETHAZINE 25 MG SUPPOSITORY

Prescription Drug - Generic

$2

—

45802080601

SALICYLIC ACID 6% CREAM

Prescription Drug - Generic

$0

—

45802081841

SALICYLIC ACID 6% LOTION

Prescription Drug - Generic

$0

—

45802084054

LEVONORGESTREL 0.75 MG TABLET

Prescription Drug - Generic

$13

—

45802089626

SULFACETAMIDE SOD 10% TOP SUSP

Prescription Drug - Generic

$1

—

45802092803

FLURANDRENOLIDE 0.05% LOTION

Prescription Drug - Generic

$1

—

45802092949

MESALAMINE 4 GM/60 ML KIT

Prescription Drug - Generic

$117

—

45802093726

HYDROCORTISONE 2.5% LOTION

Prescription Drug - Generic

$0

—

45802096272

ERY 2% PADS

Prescription Drug - Generic

$1

—

45802096696

ERYTHROMYCIN 2% GEL

Prescription Drug - Generic

$1

—

45805

Repair fistula w/colostomy

Surgery - Digestive

$1,393

—

45820

Repair rectourethral fistula

Surgery - Digestive

$1,212

—

45825

Repair fistula w/colostomy

Surgery - Digestive

$1,462

—

45900

Reduction of rectal prolapse

Surgery - Digestive

$211

—

45905

Dilation of anal sphincter

Surgery - Digestive

$169

—

45910

Dilation of rectal narrowing

Surgery - Digestive

$188

—

45915

Remove rectal obstruction

Surgery - Digestive

$232

—

45963030309

DEXTROAMPHETAMINE ER 5 MG CAP

Prescription Drug - Generic

$1

—

45963030409

DEXTROAMPHETAMINE ER 10 MG CAP

Prescription Drug - Generic

$1

—

45963030509

DEXTROAMPHETAMINE ER 15 MG CAP

Prescription Drug - Generic

$2

—

45963043864

ENULOSE 10 GM/15 ML SOLUTION

Prescription Drug - Generic

$0

—

45963043965

CONSTULOSE 10 GM/15 ML SOLN

Prescription Drug - Generic

$0

—

45990

Surg dx exam anorectal

Surgery - Digestive

$100

—

46020

Placement of seton

Surgery - Digestive

$111

—

46030

Removal anal seton oth mrk

Surgery - Digestive

$81

—

46040

I&d ischiorct&/perirct absc

Surgery - Digestive

$435

—

46045

I&d absc tranal under anes

Surgery - Digestive

$448

—

46050

I&d perianal abscess supfc

Surgery - Digestive

$104

—

46060

I&d ischiorectal/ntrmrl absc

Surgery - Digestive

$492

—

46070

Incision anal septum infant

Surgery - Digestive

$290

—

My Cost List