Medical Procedure Costs

50991049216

POLYTUSSIN DM 1-10-5 MG/5 ML SYR

Prescription Drug - Generic

$0

—

50991051001

DURAFLU TABLET

Prescription Drug - Generic

$1

—

50991053501

DURAFLU 325-20-200-60 MG TAB

Prescription Drug - Generic

$1

—

50991057801

IBUDONE 5-200 MG TABLET

Prescription Drug - Generic

$2

—

50991057901

IBUDONE 10-200 MG TABLET

Prescription Drug - Generic

$3

—

50991059816

LORTUSS DM LIQUID

Prescription Drug - Generic

$0

—

50991062601

POLY HIST FORTE 10.5-10 MG TAB

Prescription Drug - Generic

$1

—

50991072316

POLY-TUSSIN AC LIQUID

Prescription Drug - Generic

$0

—

50991073690

DECONEX IR 385-10 MG TABLET

Prescription Drug - Generic

$1

—

50991073890

DECONEX DMX 17.5-385-10 MG TAB

Prescription Drug - Generic

$1

—

50991074001

DECONEX DMX 17.5-400-10 MG TAB

Prescription Drug - Generic

$1

—

50991078260

ALA-HIST PE 2-10 MG TABLET

Prescription Drug - Generic

$0

—

50991078360

ALA-HIST IR 2 MG TABLET

Prescription Drug - Generic

$1

—

50991078490

ALAHIST CF TABLET

Prescription Drug - Generic

$1

—

50991078890

ALAHIST PE 2-7.5 MG TABLET

Prescription Drug - Generic

$1

—

50991081416

ALA-HIST DM LIQUID

Prescription Drug - Generic

$0

—

50991082616

ALAHIST DM 2-15-7.5 MG/5 ML LQ

Prescription Drug - Generic

$0

—

51020

Cystotomy/cystostomy w/fulg

Surgery - Urinary

$436

—

51040

Incise & drain bladder

Surgery - Urinary

$273

—

51045

Incise bladder/drain ureter

Surgery - Urinary

$457

—

51050

Removal of bladder stone

Surgery - Urinary

$434

—

51060

Removal of ureter stone

Surgery - Urinary

$533

—

51065

Remove ureter calculus

Surgery - Urinary

$530

—

51079056520

THIORIDAZINE 10 MG TABLET

Prescription Drug - Generic

$0

—

51079056620

THIORIDAZINE 25 MG TABLET

Prescription Drug - Generic

$1

—

51079056720

THIORIDAZINE 50 MG TABLET

Prescription Drug - Generic

$1

—

51079057220

TRIFLUOPERAZINE 1 MG TABLET

Prescription Drug - Generic

$0

—

51079057320

TRIFLUOPERAZINE 2 MG TABLET

Prescription Drug - Generic

$1

—

51079057420

TRIFLUOPERAZINE 5 MG TABLET

Prescription Drug - Generic

$1

—

51079057520

TRIFLUOPERAZINE 10 MG TABLET

Prescription Drug - Generic

$1

—

51079058020

THIORIDAZINE 100 MG TABLET

Prescription Drug - Generic

$1

—

51079062182

GRANULEX SPRAY

Prescription Drug - Generic

$0

—

51079077820

HYDROCODONE-ACETAMINOPHEN 7.5-325 TAB

Prescription Drug - Generic

$0

—

51079091720

VERAPAMIL ER 120 MG CAPSULE

Prescription Drug - Generic

$2

—

51079092420

DILTIAZEM ER 60 MG 12-HR CAP

Prescription Drug - Generic

$1

—

51079092520

DILTIAZEM ER 90 MG 12-HR CAP

Prescription Drug - Generic

$2

—

51079092620

DILTIAZEM ER 120 MG 12-HR CAP

Prescription Drug - Generic

$2

—

51079094708

DILTIAZEM ER 120 MG CAPSULE

Prescription Drug - Generic

$0

—

51079096717

DIPHENHYDRAMINE 25 MG MINITB

Prescription Drug - Generic

$0

—

51080

Drainage of bladder abscess

Surgery - Urinary

$379

—

51100

Drain bladder by needle

Surgery - Urinary

$34

—

51101

Drain bladder by trocar/cath

Surgery - Urinary

$44

—

51102

Drain bl w/cath insertion

Surgery - Urinary

$126

—

51167054834

JOURNAVX 50 MG TABLET

Prescription Drug - Brand

$15

—

51224016212

ASTRINGENT SOLN POWDER PACK

Prescription Drug - Generic

$1

—

51224040110

BENZOYL PEROXIDE 9.8% FOAM

Prescription Drug - Generic

$1

—

51248015001

VESICARE 5 MG TABLET

Prescription Drug - Brand

$12

—

51248015101

VESICARE 10 MG TABLET

Prescription Drug - Brand

$12

—

51248025099

VESICARE LS 5 MG/5 ML SUSP

Prescription Drug - Brand

$2

—

51267089099

CONTRAVE ER 8-90 MG TABLET

Prescription Drug - Brand

$5

—

My Cost List