Medical Procedure Costs

62037060090

CARTIA XT 300 MG CAPSULE

Prescription Drug - Generic

$0

—

62037069690

TAZTIA XT 120 MG CAPSULE

Prescription Drug - Generic

$0

—

62037069790

TAZTIA XT 180 MG CAPSULE

Prescription Drug - Generic

$0

—

62037069890

TAZTIA XT 240 MG CAPSULE

Prescription Drug - Generic

$0

—

62037069990

TAZTIA XT 300 MG CAPSULE

Prescription Drug - Generic

$0

—

62037070090

TAZTIA XT 360 MG CAPSULE

Prescription Drug - Generic

$1

—

62100

Repair brain fluid leakage

Surgery - Nervous

$1,456

—

62107000201

PROVIL 200 MG TABLET

Prescription Drug - Generic

$0

—

62107000984

H.E.A.R. 6.5% EAR DROP

Prescription Drug - Generic

$0

—

62107001212

IMPERIM 2 MG TABLET

Prescription Drug - Generic

$0

—

62107002211

MILANTEX LIQUID

Prescription Drug - Generic

$0

—

62107002311

MILANTEX DBL-STRENGTH LIQ

Prescription Drug - Generic

$0

—

62107002636

CHILD ASPIRIN 81 MG CHEW TAB

Prescription Drug - Generic

$0

—

62107002732

ASPIR EC 81 MG TABLET

Prescription Drug - Generic

$0

—

62107002801

ECPIRIN EC 325 MG TABLET

Prescription Drug - Generic

$0

—

62107003001

DUCODYL EC 5 MG TABLET

Prescription Drug - Generic

$0

—

62107003101

SENNO TABLET

Prescription Drug - Generic

$0

—

62107003310

DOCUSIL 100 MG SOFTGEL

Prescription Drug - Generic

$0

—

62107003910

ONCE DAILY TABLET

Prescription Drug - Generic

$0

—

62107004206

CALCIUM 600 MG TABLET

Prescription Drug - Generic

$0

—

62107005010

TACTINAL 500 MG TABLET

Prescription Drug - Generic

$0

—

62107005101

TACTINAL 500 MG CAPLET

Prescription Drug - Generic

$0

—

62107005210

TACTINAL 325 MG TABLET

Prescription Drug - Generic

$0

—

62107005330

CHILD TACTINAL 80 MG TAB CHW

Prescription Drug - Generic

$0

—

62107006301

PRENATAL TABLET

Prescription Drug - Generic

$0

—

62107007904

METAFIBER POWDER

Prescription Drug - Generic

$0

—

62107008211

LIQUID ANTACID SUSP

Prescription Drug - Generic

$0

—

62115

Reduction of skull defect

Surgery - Nervous

$1,681

—

62117

Reduction of skull defect

Surgery - Nervous

$1,906

—

62120

Repair skull cavity lesion

Surgery - Nervous

$2,145

—

62121

Incise skull repair

Surgery - Nervous

$1,433

—

62135001047

AMANTADINE 50 MG/5 ML SOLUTION

Prescription Drug - Generic

$0

—

62135019222

CALCIUM ACETATE 667 MG TABLET

Prescription Drug - Generic

$0

—

62135020060

METHENAMINE MAND 500 MG TABLET

Prescription Drug - Generic

$1

—

62135020160

METHENAMINE MAND 1 GM TABLET

Prescription Drug - Generic

$3

—

62135022060

CHLORDIAZEPOXIDE 5 MG CAPSULE

Prescription Drug - Generic

$0

—

62135022160

CHLORDIAZEPOXIDE 10 MG CAPSULE

Prescription Drug - Generic

$0

—

62135022260

CHLORDIAZEPOXIDE 25 MG CAPSULE

Prescription Drug - Generic

$0

—

62135033041

PREDNISOLONE 5 MG/5 ML SOLN

Prescription Drug - Generic

$1

—

62135033412

DILTIAZEM 60 MG TABLET

Prescription Drug - Generic

$0

—

62135033690

DILTIAZEM 120 MG TABLET

Prescription Drug - Generic

$0

—

62135034062

SODIUM POLYSTYRENE SULF POWDER

Prescription Drug - Generic

$0

—

62135043190

DISULFIRAM 250 MG TABLET

Prescription Drug - Generic

$2

—

62135043290

DISULFIRAM 500 MG TABLET

Prescription Drug - Generic

$13

—

62135043447

SOD CITRATE-CITRIC ACID SOLN

Prescription Drug - Generic

$0

—

62135043547

POTASSIUM CIT-CITRIC ACID SOLN

Prescription Drug - Generic

$0

—

62135043730

PREDNISOLONE 5 MG TABLET

Prescription Drug - Generic

$9

—

62135043847

TRICITRATES ORAL SOLUTION

Prescription Drug - Generic

$0

—

62135045660

DIFLUNISAL 500 MG TABLET

Prescription Drug - Generic

$1

—

62135047560

DANAZOL 50 MG CAPSULE

Prescription Drug - Generic

$2

—

My Cost List