Medical Procedure Costs

51672211602

FEVERALL 325 MG SUPPOSITORY

Prescription Drug - Brand

$1

—

51672215006

ADAPALENE 0.1% GEL

Prescription Drug - Generic

$0

—

51672215801

ATHLETE'S FOOT 1% SOLUTION

Prescription Drug - Generic

$3

—

51672300701

HYDROCORTISON-ACETIC ACID SOLN

Prescription Drug - Generic

$9

—

51672404501

ENALAPRIL-HYDROCHLOROTHIAZIDE 5-12.5 MG TAB

Prescription Drug - Generic

$0

—

51672404601

ENALAPRIL-HYDROCHLOROTHIAZIDE 10-25 MG TABLET

Prescription Drug - Generic

$0

—

51672404806

CLOTRIMAZOLE-BETAMETHASONE CRM

Prescription Drug - Generic

$0

—

51672406104

HYDROCORTISONE BUTYR 0.1% SOLN

Prescription Drug - Generic

$2

—

51672406201

FLUOROURACIL 2% TOPICAL SOLN

Prescription Drug - Generic

$4

—

51672406301

FLUOROURACIL 5% TOPICAL SOLN

Prescription Drug - Generic

$4

—

51672407406

HYDROCORTISONE BUTY 0.1% CREAM

Prescription Drug - Generic

$2

—

51672408301

HYDROCORTISONE BUTYR 0.1% OINT

Prescription Drug - Generic

$2

—

51672411606

METRONIDAZOLE TOPICAL 0.75% GL

Prescription Drug - Generic

$0

—

51672412501

CARBAMAZEPINE XR 400 MG TABLET

Prescription Drug - Generic

$3

—

51672416606

CLOCORTOLONE PIVALATE 0.1% CRM

Prescription Drug - Generic

$5

—

51672417406

IMIQUIMOD 3.75% CREAM

Prescription Drug - Generic

$22

—

51672417409

IMIQUIMOD 3.75% CREAM PUMP

Prescription Drug - Generic

$118

—

51672423008

IVERMECTIN 0.5% LOTION

Prescription Drug - Generic

$1

—

51672527803

CALCITRENE 0.005% OINTMENT

Prescription Drug - Generic

$3

—

51672528107

TOPICORT 0.25% SPRAY

Prescription Drug - Brand

$5

—

51672529304

OVIDE 0.5% LOTION

Prescription Drug - Brand

$3

—

51672529404

MALATHION 0.5% LOTION

Prescription Drug - Generic

$3

—

51700

Irrigation of bladder

Surgery - Urinary

$26

—

51701

Insert bladder catheter

Surgery - Urinary

$22

—

51702

Insert temp bladder cath

Surgery - Urinary

$23

—

51703

Insert bladder cath complex

Surgery - Urinary

$67

—

51705

Change of bladder tube

Surgery - Urinary

$47

—

51710

Change of bladder tube

Surgery - Urinary

$73

—

51715

Endoscopic injection/implant

Surgery - Urinary

$176

—

51720

Treatment of bladder lesion

Surgery - Urinary

$38

—

51721

Ins trurl ablt trnsdc thr us

Surgery - Urinary

$192

—

51725

Simple cystometrogram

Surgery - Urinary

$198

—

51726

Complex cystometrogram

Surgery - Urinary

$271

—

51727

Cystometrogram w/up

Surgery - Urinary

$331

—

51728

Cystometrogram w/vp

Surgery - Urinary

$337

—

51729

Cystometrogram w/vp&up

Surgery - Urinary

$354

—

51736

Urine flow measurement

Surgery - Urinary

$15

—

51741

Electro-uroflowmetry first

Surgery - Urinary

$15

—

51759020210

AJOVY 225 MG/1.5 ML AUTOINJECT

Prescription Drug - Brand

$508

—

51759020222

AJOVY 225 MG/1.5 ML AUTOINJECTOR (3 PACK)

Prescription Drug - Brand

$506

—

51759020410

AJOVY 225 MG/1.5 ML SYRINGE

Prescription Drug - Brand

$508

—

51759030510

UZEDY ER 50 MG/0.14 ML SYRINGE

Prescription Drug - Brand

$9,451

—

51759041010

UZEDY ER 75 MG/0.21 ML SYRINGE

Prescription Drug - Brand

$9,362

—

51759051321

SIMLANDI(CF) 40 MG/0.4 ML AUTOINJECTOR

Prescription Drug - Brand

$489

—

51759052010

UZEDY ER 100 MG/0.28 ML SYRING

Prescription Drug - Brand

$9,394

—

51759063010

UZEDY ER 125 MG/0.35 ML SYRING

Prescription Drug - Brand

$9,430

—

51759085010

UZEDY ER 200 MG/0.56 ML SYRING

Prescription Drug - Brand

$9,394

—

51784

Anal/urinary muscle study

Surgery - Urinary

$66

—

51785

Anal/urinary muscle study

Surgery - Urinary

$392

—

51792

Urinary reflex study

Surgery - Urinary

$247

—

My Cost List