Medical Procedure Costs

68016034306

PV SORE THROAT 1.4% SPRAY

Prescription Drug - Generic

$0

—

68016045315

PV ACID REDUCER 75 MG TABLET

Prescription Drug - Generic

$0

—

68016046420

PV NAPROXEN SOD 220 MG TABLET

Prescription Drug - Generic

$0

—

68016046600

PV SALINE 0.65% NASAL SPRAY

Prescription Drug - Generic

$0

—

68016054254

PV GLUCOSE 4 GRAM TABLET CHEW

Prescription Drug - Generic

$0

—

68016069257

ANTI-GAS ULTRA STR SOFTGEL

Prescription Drug - Generic

$0

—

68016071182

SINUS & ALLERGY TABLET

Prescription Drug - Generic

$0

—

68016082354

PV CHILD ALLERGY 12.5 MG/5 ML

Prescription Drug - Generic

$0

—

68016082356

CHILDREN'S ALLERGY LIQUID

Prescription Drug - Generic

$0

—

68016085554

PV TUSSIN DM SYRUP

Prescription Drug - Generic

$0

—

68016085756

PV TUSSIN 100 MG/5 ML SYRUP

Prescription Drug - Generic

$0

—

68020

Incise/drain eyelid lining

Surgery - Eye

$95

—

68025004430

OB COMPLETE ONE SOFTGEL

Prescription Drug - Brand

$8

—

68025004610

LORZONE 375 MG TABLET

Prescription Drug - Brand

$6

—

68025004710

LORZONE 750 MG TABLET

Prescription Drug - Brand

$11

—

68025005330

CONZIP 100 MG CAPSULE

Prescription Drug - Brand

$9

—

68025005530

CONZIP 200 MG CAPSULE

Prescription Drug - Brand

$12

—

68025005930

OB COMPLETE PETITE SOFTGEL

Prescription Drug - Brand

$8

—

68025006030

CORVITE FE TABLET

Prescription Drug - Brand

$4

—

68025006430

NEXA PLUS SOFTGEL

Prescription Drug - Brand

$4

—

68025006530

DIVIGEL 0.25 MG GEL PACKET

Prescription Drug - Brand

$5

—

68025006630

DIVIGEL 0.5 MG GEL PACKET

Prescription Drug - Brand

$5

—

68025006730

DIVIGEL 1 MG GEL PACKET

Prescription Drug - Brand

$5

—

68025006830

OB COMPLETE GOLD SOFTGEL

Prescription Drug - Brand

$4

—

68025008330

DIVIGEL 0.75 MG GEL PACKET

Prescription Drug - Brand

$5

—

68025008630

DIVIGEL 1.25 MG GEL PACKET

Prescription Drug - Brand

$4

—

68025009630

RELEXXII ER 27 MG TABLET

Prescription Drug - Brand

$12

—

68025009730

RELEXXII ER 36 MG TABLET

Prescription Drug - Brand

$12

—

68040

Treatment of eyelid lesions

Surgery - Eye

$40

—

68047012016

LOHIST-D LIQUID

Prescription Drug - Generic

$0

—

68047012916

LOHIST-DM SYRUP

Prescription Drug - Generic

$0

—

68047014316

ENDACOF-DM LIQUID

Prescription Drug - Generic

$0

—

68047015701

EXEFEN IR TABLET

Prescription Drug - Generic

$0

—

68047018516

NOHIST-LQ LIQUID

Prescription Drug - Generic

$0

—

68047018616

NOHIST-DM LIQUID

Prescription Drug - Generic

$0

—

68047025201

OSCIMIN 0.125 MG TABLET

Prescription Drug - Generic

$0

—

68047025301

OSCIMIN SL 0.125 MG TABLET

Prescription Drug - Generic

$0

—

68047025401

OSCIMIN 0.125 MG ODT

Prescription Drug - Generic

$0

—

68047025501

OSCIMIN SR 0.375 MG TABLET

Prescription Drug - Generic

$0

—

68047035016

Y-COF DMX LIQUID

Prescription Drug - Generic

$0

—

68047071460

DOXYCYCLINE HYCLATE 20 MG TAB

Prescription Drug - Generic

$0

—

68084005490

DILTIAZEM 24HR CD 240 MG CAP

Prescription Drug - Generic

$0

—

68084005921

ZAFIRLUKAST 20 MG TABLET

Prescription Drug - Generic

$1

—

68084008311

ISOSORBIDE DN 20 MG TABLET

Prescription Drug - Generic

$1

—

68084010311

ZIPRASIDONE HCL 20 MG CAPSULE

Prescription Drug - Generic

$0

—

68084010411

ZIPRASIDONE HCL 40 MG CAPSULE

Prescription Drug - Generic

$0

—

68084010511

ZIPRASIDONE HCL 60 MG CAPSULE

Prescription Drug - Generic

$0

—

68084010611

ZIPRASIDONE HCL 80 MG CAPSULE

Prescription Drug - Generic

$0

—

68084011911

MIRTAZAPINE 15 MG TABLET

Prescription Drug - Generic

$0

—

68084012011

MIRTAZAPINE 30 MG TABLET

Prescription Drug - Generic

$0

—

My Cost List