Medical Procedure Costs

59762054202

GLIPIZIDE XL 10 MG TABLET

Prescription Drug - Generic

$0

—

59762080006

TOLTERODINE TARTRATE 2 MG TAB

Prescription Drug - Generic

$0

—

59762112201

BENZONATATE PERLE 100 MG CAP

Prescription Drug - Generic

$0

—

59762121003

DESVENLAFAXINE SUC ER 25 MG TB

Prescription Drug - Generic

$1

—

59762235007

ETHOSUXIMIDE 250 MG/5 ML SOLN

Prescription Drug - Generic

$0

—

59762305105

AZITHROMYCIN 1 GM PWD PACKET

Prescription Drug - Generic

$17

—

59762374401

CLINDAMYCIN PHOSP 1% LOTION

Prescription Drug - Generic

$0

—

59762500901

CLINDAMYCIN 2% VAGINAL CREAM

Prescription Drug - Generic

$2

—

59762502901

FLUCONAZOLE 10 MG/ML SUSP

Prescription Drug - Generic

$0

—

59762521001

PHENYTOIN 50 MG INFATAB

Prescription Drug - Generic

$0

—

59762600201

OXAPROZIN 600 MG CAPLET

Prescription Drug - Generic

$1

—

59767000802

PERTZYE DR 8,000 UNIT CAPSULE

Prescription Drug - Brand

$3

—

59767001601

PERTZYE DR 16,000 UNITS CAPS

Prescription Drug - Brand

$4

—

59767001602

PERTZYE DR 16,000 UNIT CAPSULE

Prescription Drug - Brand

$5

—

59767002402

PERTZYE DR 24,000 UNIT CAPSULE

Prescription Drug - Brand

$8

—

59812

Treatment of miscarriage

Surgery - Maternity

$280

—

59820

Care of miscarriage

Surgery - Maternity

$351

—

59821

Treatment of miscarriage

Surgery - Maternity

$344

—

59830

Treat uterus infection

Surgery - Maternity

$419

—

59840

Induced abortion d&c

Surgery - Maternity

$201

—

59841

Induced abortion dilat&evac

Surgery - Maternity

$336

—

59850

Induced abortion 1+ njx

Surgery - Maternity

$355

—

59851

Induced abortion 1+njx d&c

Surgery - Maternity

$387

—

59852

Induced abortion 1+njx hyst

Surgery - Maternity

$530

—

59855

Induced abortion 1+vag supp

Surgery - Maternity

$386

—

59856

Induced ab 1+vag supp d&c

Surgery - Maternity

$449

—

59857

Induced ab 1+vag supp hyst

Surgery - Maternity

$522

—

59866

Abortion (mpr)

Surgery - Maternity

$213

—

59870

Evacuate mole of uterus

Surgery - Maternity

$483

—

59871

Remove cerclage suture

Surgery - Maternity

$121

—

59922063101

AURYXIA 210 MG TABLET

Prescription Drug - Brand

$7

—

60000

I&d thyroglssl dux cst infct

Surgery - Endocrine

$146

—

60100

Biopsy of thyroid

Surgery - Endocrine

$65

—

60200

Remove thyroid lesion

Surgery - Endocrine

$622

—

60210

Partial thyroid excision

Surgery - Endocrine

$647

—

60212

Partial thyroid excision

Surgery - Endocrine

$973

—

60219236602

PILOCARPINE HCL 1.25% EYE DROP

Prescription Drug - Generic

$23

—

60220

Partial removal of thyroid

Surgery - Endocrine

$640

—

60225

Partial removal of thyroid

Surgery - Endocrine

$849

—

60240

Removal of thyroid

Surgery - Endocrine

$830

—

60252

Removal of thyroid

Surgery - Endocrine

$1,179

—

60254

Extensive thyroid surgery

Surgery - Endocrine

$1,482

—

60258000116

CYTRA-2 ORAL SOLUTION

Prescription Drug - Generic

$0

—

60258000216

CYTRA-3 SYRUP

Prescription Drug - Generic

$0

—

60258000316

CYTRA-K ORAL SOLUTION

Prescription Drug - Generic

$0

—

60258000501

CYTRA-K CRYSTALS PACKET

Prescription Drug - Generic

$1

—

60258000601

PHOS-NAK PACKET

Prescription Drug - Generic

$0

—

60258015001

SF 5000 PLUS CREAM

Prescription Drug - Generic

$0

—

60258015101

SF 1.1% GEL

Prescription Drug - Generic

$0

—

60258015910

STANNOUS FLUOR 0.63% RINSE

Prescription Drug - Generic

$0

—

My Cost List