Medical Procedure Costs

62327

Njx interlaminar lmbr/sac

Surgery - Nervous

$93

—

62328

Dx lmbr spi pnxr w/fluor/ct

Surgery - Nervous

$73

—

62329

Ther spi pnxr csf fluor/ct

Surgery - Nervous

$93

—

62330

Dcmprn prq rmv lig flv 1lmbr

Surgery - Nervous

$479

—

62331

Dcmprn prq rmv lig flv addl

Surgery - Nervous

$189

—

62332001850

METRONIDAZOLE 375 MG CAPSULE

Prescription Drug - Generic

$7

—

62332004190

IRBESARTAN 75 MG TABLET

Prescription Drug - Generic

$0

—

62332004290

IRBESARTAN 150 MG TABLET

Prescription Drug - Generic

$0

—

62332004390

IRBESARTAN 300 MG TABLET

Prescription Drug - Generic

$0

—

62332005190

IRBESARTAN-HYDROCHLOROTHIAZIDE 150-12.5 MG TB

Prescription Drug - Generic

$0

—

62332005290

IRBESARTAN-HYDROCHLOROTHIAZIDE 300-12.5 MG TB

Prescription Drug - Generic

$0

—

62332010790

ROPINIROLE HCL ER 2 MG TABLET

Prescription Drug - Generic

$0

—

62332010890

ROPINIROLE HCL ER 4 MG TABLET

Prescription Drug - Generic

$1

—

62332010930

ROPINIROLE HCL ER 6 MG TABLET

Prescription Drug - Generic

$1

—

62332011090

ROPINIROLE HCL ER 8 MG TABLET

Prescription Drug - Generic

$1

—

62332011130

ROPINIROLE HCL ER 12 MG TABLET

Prescription Drug - Generic

$2

—

62332011631

METOPROLOL-HYDROCHLOROTHIAZIDE 100-25 MG TAB

Prescription Drug - Generic

$1

—

62332015630

PRAMIPEXOLE ER 1.5 MG TABLET

Prescription Drug - Generic

$2

—

62332015730

PRAMIPEXOLE ER 2.25 MG TABLET

Prescription Drug - Generic

$2

—

62332015830

PRAMIPEXOLE ER 3 MG TABLET

Prescription Drug - Generic

$3

—

62332015930

PRAMIPEXOLE ER 4.5 MG TABLET

Prescription Drug - Generic

$2

—

62332016030

PRAMIPEXOLE ER 3.75 MG TABLET

Prescription Drug - Generic

$2

—

62332019860

ASENAPINE 5 MG TABLET SL

Prescription Drug - Generic

$2

—

62332019960

ASENAPINE 10 MG TABLET SL

Prescription Drug - Generic

$2

—

62332023504

VARDENAFIL HCL 10 MG ODT

Prescription Drug - Generic

$21

—

62332034190

CANDESARTAN CILEXETIL 4 MG TAB

Prescription Drug - Generic

$1

—

62332034290

CANDESARTAN CILEXETIL 8 MG TAB

Prescription Drug - Generic

$1

—

62332036406

CLONAZEPAM 0.125 MG ODT

Prescription Drug - Generic

$1

—

62332036506

CLONAZEPAM 0.25 MG ODT

Prescription Drug - Generic

$0

—

62332036606

CLONAZEPAM 0.5 MG ODT

Prescription Drug - Generic

$0

—

62332036706

CLONAZEPAM 1 MG ODT

Prescription Drug - Generic

$1

—

62332036806

CLONAZEPAM 2 MG ODT

Prescription Drug - Generic

$1

—

62332048231

DOXYCYCLINE HYC DR 100 MG TAB

Prescription Drug - Generic

$2

—

62332048331

DOXYCYCLINE HYC DR 150 MG TAB

Prescription Drug - Generic

$1

—

62332049960

DOXYCYCLINE 50 MG TABLET

Prescription Drug - Generic

$5

—

62332050503

MOXIFLOXACIN 0.5% EYE DROP

Prescription Drug - Generic

$6

—

62332051105

BIMATOPROST 0.03% EYELASH SOLN

Prescription Drug - Generic

$21

—

62332054460

ASENAPINE 2.5 MG TABLET SL

Prescription Drug - Generic

$3

—

62332055059

DESONIDE 0.05% LOTION

Prescription Drug - Generic

$1

—

62332058231

LIDOCAINE-PRILOCAINE CREAM

Prescription Drug - Generic

$0

—

62332058560

NYSTATIN-TRIAMCINOLONE OINTMENT

Prescription Drug - Generic

$0

—

62332058631

AMANTADINE 100 MG TABLET

Prescription Drug - Generic

$0

—

62332074130

ACITRETIN 10 MG CAPSULE

Prescription Drug - Generic

$2

—

62332074230

ACITRETIN 17.5 MG CAPSULE

Prescription Drug - Generic

$7

—

62332074330

ACITRETIN 25 MG CAPSULE

Prescription Drug - Generic

$3

—

62332080945

TRETINOIN 0.025% CREAM

Prescription Drug - Generic

$1

—

62332082330

DEXLANSOPRAZOLE DR 30 MG CAP

Prescription Drug - Generic

$5

—

62332082490

DEXLANSOPRAZOLE DR 60 MG CAP

Prescription Drug - Generic

$4

—

62350

Implant spinal canal cath

Surgery - Nervous

$378

—

62351

Implant spinal canal cath

Surgery - Nervous

$914

—

My Cost List