Medical Procedure Costs

50419052435

BETASERON 0.3 MG KIT

Prescription Drug - Brand

$725

—

50419054002

KERENDIA 10 MG TABLET

Prescription Drug - Brand

$23

—

50419054102

KERENDIA 20 MG TABLET

Prescription Drug - Brand

$23

—

50419074701

BILTRICIDE 600 MG TABLET

Prescription Drug - Brand

$82

—

50419077301

CIPRO 10% SUSPENSION

Prescription Drug - Brand

$1

—

50419077701

CIPRO 5% SUSPENSION

Prescription Drug - Brand

$1

—

50419082502

FINACEA 15% GEL

Prescription Drug - Brand

$7

—

50419082806

DESONATE 0.05% GEL

Prescription Drug - Brand

$10

—

50430

Njx px nfrosgrm &/urtrgrm

Surgery - Urinary

$136

—

50431

Njx px nfrosgrm &/urtrgrm

Surgery - Urinary

$59

—

50432

Plmt nephrostomy catheter

Surgery - Urinary

$178

—

50433

Plmt nephroureteral catheter

Surgery - Urinary

$219

—

50434

Convert nephrostomy catheter

Surgery - Urinary

$167

—

50435

Exchange nephrostomy cath

Surgery - Urinary

$88

—

50436

Dilat xst trc ndurlgc px

Surgery - Urinary

$136

—

50437

Dilat xst trc new access rcs

Surgery - Urinary

$224

—

50458002802

SPRAVATO 56 MG DOSE PACK

Prescription Drug - Brand

$426

—

50458002803

SPRAVATO 84 MG DOSE PACK

Prescription Drug - Brand

$427

—

50458009005

DURAGESIC 12 MCG/HR PATCH

Prescription Drug - Brand

$37

—

50458009105

DURAGESIC 25 MCG/HR PATCH

Prescription Drug - Brand

$44

—

50458009305

DURAGESIC 75 MCG/HR PATCH

Prescription Drug - Brand

$123

—

50458009801

ELMIRON 100 MG CAPSULE

Prescription Drug - Brand

$12

—

50458010405

DURAGESIC 50 MCG/HR PATCH

Prescription Drug - Brand

$80

—

50458010605

DURAGESIC 100 MCG/HR PATCH

Prescription Drug - Brand

$163

—

50458014090

INVOKANA 100 MG TABLET

Prescription Drug - Brand

$19

—

50458014190

INVOKANA 300 MG TABLET

Prescription Drug - Brand

$19

—

50458017615

ORTHO-NOVUM 1-35-28 TABLET

Prescription Drug - Brand

$2

—

50458017820

ORTHO-NOVUM 7-7-7-28 TABLET

Prescription Drug - Brand

$1

—

50458019112

ORTHO TRI-CYCLEN 28 TABLET

Prescription Drug - Brand

$2

—

50458019224

ORTHO EVRA PATCH

Prescription Drug - Brand

$35

—

50458019412

ORTHO MICRONOR 0.35 MG TABLET

Prescription Drug - Brand

$2

—

50458019712

ORTHO-CYCLEN 28 TABLET

Prescription Drug - Brand

$2

—

50458021001

AXERT 12.5 MG TABLET

Prescription Drug - Brand

$41

—

50458021101

AXERT 6.25 MG TABLET

Prescription Drug - Brand

$41

—

50458025106

ORTHO TRI-CYCLEN LO TABLET

Prescription Drug - Brand

$5

—

50458029004

SPORANOX 100 MG CAPSULE

Prescription Drug - Brand

$28

—

50458029515

SPORANOX 10 MG/ML SOLUTION

Prescription Drug - Brand

$2

—

50458030006

RISPERDAL 1 MG TABLET

Prescription Drug - Brand

$5

—

50458030101

RISPERDAL 0.25 MG TABLET

Prescription Drug - Brand

$7

—

50458030206

RISPERDAL 0.5 MG TABLET

Prescription Drug - Brand

$4

—

50458030503

RISPERDAL 1 MG/ML SOLUTION

Prescription Drug - Brand

$5

—

50458030611

RISPERDAL CONSTA 25 MG VIAL

Prescription Drug - Brand

$640

—

50458030711

RISPERDAL CONSTA 37.5 MG SYR

Prescription Drug - Brand

$732

—

50458030811

RISPERDAL CONSTA 50 MG VIAL

Prescription Drug - Brand

$1,278

—

50458030911

RISPERDAL CONSTA 12.5 MG VIAL

Prescription Drug - Brand

$318

—

50458032006

RISPERDAL 2 MG TABLET

Prescription Drug - Brand

$8

—

50458033006

RISPERDAL 3 MG TABLET

Prescription Drug - Brand

$9

—

50458034160

PANCREAZE DR 4,200 UNIT CAP

Prescription Drug - Brand

$1

—

50458034260

PANCREAZE DR 10,500 UNIT CAP

Prescription Drug - Brand

$3

—

50458034360

PANCREAZE DR 16,800 UNIT CAP

Prescription Drug - Brand

$4

—

My Cost List