Medical Procedure Costs

00135019605

NICODERM CQ 7 MG/24HR PATCH

Prescription Drug - Brand

$3

—

00135019902

CITRUCEL 500 MG CAPLET

Prescription Drug - Brand

$0

—

00135020005

ABREVA 10% CREAM

Prescription Drug - Brand

$8

—

00135024105

NICORETTE 2 MG CHEWING GUM

Prescription Drug - Brand

$0

—

00135024208

NICORETTE 4 MG CHEWING GUM

Prescription Drug - Brand

$0

—

00135043003

GAVISCON ES TABLET CHEW

Prescription Drug - Brand

$0

—

00135045603

TUMS SMOOTHIES CHEW TABLET

Prescription Drug - Brand

$0

—

00135046105

ALLI 60 MG CAPSULE

Prescription Drug - Brand

$0

—

00135046901

TUMS KIDS 300 MG (750) CHEWTAB

Prescription Drug - Brand

$0

—

00135050804

NICORETTE 2 MG MINI LOZENGE

Prescription Drug - Brand

$0

—

00135050902

NICORETTE 4 MG MINI LOZENGE

Prescription Drug - Brand

$0

—

00135051403

NICORETTE 2 MG LOZENGE

Prescription Drug - Brand

$0

—

00135051503

NICORETTE 4 MG LOZENGE

Prescription Drug - Brand

$0

—

00135052202

TUMS FRESHERS ANTACID CHEW TAB

Prescription Drug - Brand

$0

—

00135056001

TUMS ULTRA STR CHEWY DELIGHTS

Prescription Drug - Brand

$0

—

00135057401

GAVISCON EXTRA STRENGTH LIQUID

Prescription Drug - Brand

$0

—

00135057603

FLONASE ALLERGY RLF 50 MCG SPR

Prescription Drug - Brand

$1

—

00135058201

CHILD FLONASE ALLER RLF 50 MCG

Prescription Drug - Brand

$1

—

00135060602

TUMS 750 MG CHEWY BITES

Prescription Drug - Brand

$0

—

00135061101

TUMS TABLET CHEWABLE

Prescription Drug - Brand

$0

—

00135061503

FLONASE SENSIMIST 27.5 MCG SPR

Prescription Drug - Brand

$2

—

00135061601

CHLD FLONASE SENSIMIST 27.5 MCG

Prescription Drug - Brand

$2

—

0013M

Molecular pathology test for genetic analysis of recurrent bladder tumor

Pathology/Laboratory

$760

—

00143120201

CORTISONE 25 MG TABLET

Prescription Drug - Generic

$2

—

00143121001

CHLOROTHIAZIDE 500 MG TABLET

Prescription Drug - Generic

$1

—

00143133301

ISOSORBIDE MN 20 MG TABLET

Prescription Drug - Generic

$0

—

00143915801

FUROSEMIDE 500 MG/50 ML VIAL

Prescription Drug - Generic

$0

—

00143915901

FUROSEMIDE 1,000 MG/100 ML VL

Prescription Drug - Generic

$0

—

00143972501

PROGESTERONE OIL 50 MG/ML VL

Prescription Drug - Generic

$3

—

00143975001

TESTOSTERON ENAN 1,000 MG/5 ML

Prescription Drug - Generic

$14

—

00145007130

VELTIN GEL

Prescription Drug - Brand

$11

—

00145009025

SORIATANE 10 MG CAPSULE

Prescription Drug - Brand

$43

—

00145009125

SORIATANE 25 MG CAPSULE

Prescription Drug - Brand

$52

—

00145062805

SARNA ORIGINAL 0.5%-0.5% LOTN

Prescription Drug - Brand

$0

—

00145098305

PANOXYL 10% ACNE CLEANSING BAR

Prescription Drug - Brand

$4

—

00145098505

PANOXYL 10% ACNE FOAMING WASH

Prescription Drug - Brand

$0

—

00145150103

ZEASORB 2% POWDER

Prescription Drug - Generic

$0

—

00145237105

DUAC 1.2-5% GEL

Prescription Drug - Brand

$7

—

00145266005

PANOXYL-4 ACNE CREAMY WASH

Prescription Drug - Brand

$0

—

0015M

Molecular pathology test for genetic analysis of kidney gland tumor (Adrenal

Pathology/Laboratory

$1,305

—

00168000730

NYSTATIN 100,000 UNITS/GM OINT

Prescription Drug - Generic

$0

—

00168001631

HYDROCORTISONE 0.5% OINTMENT

Prescription Drug - Generic

$0

—

00168002135

BACITRACIN-POLYMYXIN OINTMENT

Prescription Drug - Generic

$0

—

00168004160

BETAMETHASONE VA 0.1% LOTION

Prescription Drug - Generic

$1

—

00168012691

SWIM EAR DROPS

Prescription Drug - Generic

$0

—

00168013330

CLOTRIMAZOLE 1% CREAM

Prescription Drug - Generic

$0

—

00168024630

FLUOCINONIDE-EMOL 0.05% CREAM

Prescription Drug - Generic

$2

—

00168047914

LIDOCAINE 3%-HC 0.5% CREAM

Prescription Drug - Generic

$2

—

00169008181

PRANDIN 0.5 MG TABLET

Prescription Drug - Brand

$6

—

00169008281

PRANDIN 1 MG TABLET

Prescription Drug - Brand

$6

—

My Cost List