Medical Procedure Costs

51991007301

BUTALBITAL-CAFF-ACETAMINOPHEN-COD CAP

Prescription Drug - Generic

$1

—

51991007405

ASCOMP WITH CODEINE CAPSULE

Prescription Drug - Generic

$1

—

51991008290

FOLBEE PLUS TABLET

Prescription Drug - Generic

$0

—

51991008490

FOLBEE TABLET

Prescription Drug - Generic

$1

—

51991015501

VINATE-M TABLET

Prescription Drug - Generic

$0

—

51991015990

VINATE GT TABLET

Prescription Drug - Generic

$0

—

51991018142

FERROCITE TABLET

Prescription Drug - Generic

$0

—

51991018211

FERROCITE PLUS TABLET

Prescription Drug - Generic

$0

—

51991019811

FERREX 150 FORTE CAPSULE

Prescription Drug - Generic

$0

—

51991020311

FERREX 150 CAPSULE

Prescription Drug - Generic

$0

—

51991025201

FOLPLEX 2.2 TABLET

Prescription Drug - Generic

$0

—

51991031133

DESVENLAFAXINE SUC ER 50 MG TB

Prescription Drug - Generic

$1

—

51991038490

FOLBIC TABLET

Prescription Drug - Generic

$1

—

51991047428

ESTRADIOL-NORETH 1-0.5 MG TAB

Prescription Drug - Generic

$1

—

51991052890

FOLBEE PLUS CZ TABLET

Prescription Drug - Generic

$1

—

51991054390

MULTIGEN CAPLET

Prescription Drug - Generic

$1

—

51991054490

MULTIGEN PLUS CAPLET

Prescription Drug - Generic

$1

—

51991056601

VINATE ONE TABLET

Prescription Drug - Generic

$0

—

51991058828

FERREX 28 TABLET

Prescription Drug - Generic

$1

—

51991062328

ESTRADIOL-NORETH 0.5-0.1 MG TB

Prescription Drug - Generic

$1

—

51991063501

FEROCON CAPSULE

Prescription Drug - Generic

$0

—

51991064501

V-C FORTE CAPSULE

Prescription Drug - Generic

$0

—

51991070390

FERREX 150 PLUS CAPSULE

Prescription Drug - Generic

$1

—

51991079890

FERREX 150 FORTE PLUS CAPSULE

Prescription Drug - Generic

$1

—

51991081905

PROPRANOLOL ER 120 MG CAPSULE

Prescription Drug - Generic

$0

—

51991082005

PROPRANOLOL ER 160 MG CAPSULE

Prescription Drug - Generic

$0

—

51992

Laparo sling operation

Surgery - Urinary

$747

—

52000

Cystourethroscopy

Surgery - Urinary

$71

—

52001

Cysto w/irrg&evac mlt clots

Surgery - Urinary

$253

—

52005

Cysto w/urtrl cathj

Surgery - Urinary

$120

—

52007

Cysto urtrl cathj brush bx

Surgery - Urinary

$148

—

52010

Cystoscopy & duct catheter

Surgery - Urinary

$147

—

52015008001

DIFICID 200 MG TABLET

Prescription Drug - Brand

$249

—

52054051409

DEXEDRINE SPANSULE 15 MG

Prescription Drug - Brand

$17

—

52054055022

ALBENZA 200 MG TABLET

Prescription Drug - Brand

$232

—

52054080302

ADRENACLICK 0.15 MG AUTO-INJCT

Prescription Drug - Brand

$161

—

52054080402

ADRENACLICK 0.3 MG AUTO-INJECT

Prescription Drug - Brand

$149

—

52204

Cystoscopy w/biopsy(s)

Surgery - Urinary

$127

—

52214

Cystoscopy and treatment

Surgery - Urinary

$152

—

52224

Cystoscopy and treatment

Surgery - Urinary

$176

—

52234

Cystoscopy and treatment

Surgery - Urinary

$217

—

52235

Cystoscopy and treatment

Surgery - Urinary

$255

—

52240

Cystoscopy and treatment

Surgery - Urinary

$344

—

52244002002

EDEX 20 MCG CARTRIDGE 2-PK KIT

Prescription Drug - Brand

$237

—

52244010010

THEO-24 ER 100 MG CAPSULE

Prescription Drug - Brand

$4

—

52244020010

THEO-24 ER 200 MG CAPSULE

Prescription Drug - Brand

$6

—

52244030010

THEO-24 ER 300 MG CAPSULE

Prescription Drug - Brand

$7

—

52244040010

THEO-24 ER 400 MG CAPSULE

Prescription Drug - Brand

$10

—

52244040410

SEMPREX-D 8 MG-60 MG CAPSULE

Prescription Drug - Brand

$6

—

52250

Cystoscopy and radiotracer

Surgery - Urinary

$212

—

My Cost List