Medical Procedure Costs

00113810103

OPILL 0.075 MG TABLET

Prescription Drug - Brand

$0

—

00113860025

GS NICOTINE 4 MG CHEWING GUM

Prescription Drug - Generic

$0

—

00113895926

GS CHLD PAIN-FEVER 160 MG/5 ML

Prescription Drug - Generic

$0

—

00113945866

GS ALL DAY ALLERGY 10 MG TAB

Prescription Drug - Generic

$0

—

00115155701

OXYCODONE HCL ER 15 MG TABLET

Prescription Drug - Generic

$4

—

00115155901

OXYCODONE HCL ER 30 MG TABLET

Prescription Drug - Generic

$6

—

00115156101

OXYCODONE HCL ER 60 MG TABLET

Prescription Drug - Generic

$10

—

00115167601

ALENDRONATE SODIUM 5 MG TABLET

Prescription Drug - Generic

$0

—

00115531101

NADOLOL-BENDROFLU 40-5 MG TAB

Prescription Drug - Generic

$2

—

00116106140

DYNA-HEX 4% LIQUID

Prescription Drug - Brand

$0

—

00116402416

PROMETHAZINE-DM 6.25-15 MG/5 ML SYRUP

Prescription Drug - Generic

$0

—

0011M

Molecular pathology test for genetic analysis of prostate tumor (NeoLAB

Pathology/Laboratory

$760

—

0011U

Prescription drug monitoring in oral fluid

Pathology/Laboratory

$114

—

00121065816

TRIHEXYPHENIDYL 2 MG/5 ML SOLN

Prescription Drug - Generic

$0

—

00121072716

RANITIDINE 15 MG/ML SYRUP

Prescription Drug - Generic

$0

—

00121076616

CALCIUM CARB 1,250 MG/5 ML SUS

Prescription Drug - Generic

$0

—

00121077204

HYDROCODONE-ACETAMINOPHEN 7.5 MG-325 MG/15 ML SOLUTION

Prescription Drug - Generic

$0

—

00121077516

GUAIFENESIN-CODEINE SYRUP

Prescription Drug - Generic

$0

—

00121085416

SULFATRIM PEDIATRIC SUSPENSION

Prescription Drug - Generic

$0

—

00121115440

LACTULOSE 20 GM/30 ML SOLUTION CUP

Prescription Drug - Generic

$0

—

0012M

Molecular pathology test for genetic analysis of bladder tumor (Cxbladder

Pathology/Laboratory

$760

—

00131247760

VIMPAT 50 MG TABLET

Prescription Drug - Brand

$12

—

00131247860

VIMPAT 100 MG TABLET

Prescription Drug - Brand

$19

—

00131247960

VIMPAT 150 MG TABLET

Prescription Drug - Brand

$20

—

00131248060

VIMPAT 200 MG TABLET

Prescription Drug - Brand

$20

—

00131541072

VIMPAT 10 MG/ML SOLUTION

Prescription Drug - Brand

$2

—

00132007950

FLEET GLYCERIN 2 GM ADULT SUPP

Prescription Drug - Brand

$0

—

00132010624

FLEET PEDIA-LAX STOOL SOFTENER

Prescription Drug - Brand

$0

—

00132018582

FLEET GLYCERIN LIQUID SUPP

Prescription Drug - Brand

$0

—

00132019012

FLEET PEDIA-LAX SUPPOSITORIES

Prescription Drug - Brand

$0

—

00132020142

FLEET ENEMA

Prescription Drug - Brand

$0

—

00132020220

FLEET PEDIA-LAX ENEMA

Prescription Drug - Brand

$0

—

00132020812

PHAZYME 180 MG SOFTGEL

Prescription Drug - Brand

$0

—

00132021112

PHAZYME 250 MG SOFTGEL

Prescription Drug - Brand

$0

—

00132030140

FLEET MINERAL OIL ENEMA

Prescription Drug - Brand

$0

—

00132065501

FLEET PEDIA-LAX TABLET CHEW

Prescription Drug - Brand

$0

—

00132070336

FLEET BISACODYL 10 MG ENEMA

Prescription Drug - Brand

$0

—

00132070402

FLEET BISACODYL EC 5 MG TAB

Prescription Drug - Brand

$0

—

00132075160

SOF-LAX 100 MG GELCAP

Prescription Drug - Generic

$0

—

00135005707

SOMINEX 25 MG TABLET

Prescription Drug - Generic

$0

—

00135007401

TUMS X-STR 750 TABLET CHEWABLE

Prescription Drug - Brand

$0

—

00135007424

TUMS E-X TABLET CHEWABLE

Prescription Drug - Brand

$0

—

00135008969

CITRUCEL POWDER

Prescription Drug - Brand

$0

—

00135009070

CITRUCEL POWDER S-F

Prescription Drug - Brand

$0

—

00135009441

GAVISCON LIQUID

Prescription Drug - Brand

$0

—

00135009541

GAVISCON EXTRA STRENGTH LIQ

Prescription Drug - Brand

$0

—

00135009626

GAVISCON 80-14.2 MG TAB CHEW

Prescription Drug - Brand

$0

—

00135018301

TUMS ULTRA TABLET CHEWABLE

Prescription Drug - Brand

$0

—

00135019402

NICODERM CQ 21 MG/24HR PATCH

Prescription Drug - Brand

$3

—

00135019503

NICODERM CQ 14 MG/24HR PATCH

Prescription Drug - Brand

$3

—

My Cost List