Medical Procedure Costs

69036013016

LORTUSS EX LIQUID

Prescription Drug - Generic

$0

—

69076020060

RILUZOLE 50 MG TABLET

Prescription Drug - Generic

$0

—

69087015812

JATENZO 158 MG CAPSULE

Prescription Drug - Brand

$9

—

69087019812

JATENZO 198 MG CAPSULE

Prescription Drug - Brand

$9

—

69087023712

JATENZO 237 MG CAPSULE

Prescription Drug - Brand

$18

—

69097000467

HYDROCORTISONE SS 100 MG VIAL

Prescription Drug - Generic

$15

—

69097030102

EFAVIRENZ 600 MG TABLET

Prescription Drug - Generic

$1

—

69097032187

BUDESONIDE 1 MG/2 ML INH SUSP

Prescription Drug - Generic

$4

—

69097036108

GRISEOFULVIN 125 MG/5 ML SUSP

Prescription Drug - Generic

$0

—

69097036202

ABACAVIR-LAMIVUDINE 600-300 MG

Prescription Drug - Generic

$1

—

69097036344

TESTOSTERONE 30 MG/1.5 ML PUMP

Prescription Drug - Generic

$1

—

69097042502

ENTECAVIR 1 MG TABLET

Prescription Drug - Generic

$0

—

69097042602

ENTECAVIR 0.5 MG TABLET

Prescription Drug - Generic

$0

—

69097045905

FENOFIBRATE 48 MG TABLET

Prescription Drug - Generic

$0

—

69097050731

ESOMEPRAZOLE DR 2.5 MG PACKET

Prescription Drug - Generic

$7

—

69097050831

ESOMEPRAZOLE DR 5 MG PACKET

Prescription Drug - Generic

$6

—

69097051403

ABACAVIR 300 MG TABLET

Prescription Drug - Generic

$1

—

69097051607

CYCLOPHOSPHAMIDE 25 MG CAPSULE

Prescription Drug - Generic

$1

—

69097051707

CYCLOPHOSPHAMIDE 50 MG CAPSULE

Prescription Drug - Generic

$2

—

69097052734

ESOMEPRAZOLE DR 10 MG PACKET

Prescription Drug - Generic

$6

—

69097052834

ESOMEPRAZOLE DR 20 MG PACKET

Prescription Drug - Generic

$6

—

69097052934

ESOMEPRAZOLE DR 40 MG PACKET

Prescription Drug - Generic

$6

—

69097064202

EMTRICITABINE 200 MG CAPSULE

Prescription Drug - Generic

$15

—

69097065502

RITONAVIR 100 MG TABLET

Prescription Drug - Generic

$1

—

69097080237

TESTOSTERON CYP 2,000 MG/10 ML

Prescription Drug - Generic

$4

—

69097097207

FOSINOPRIL-HYDROCHLOROTHIAZIDE 10-12.5 MG TAB

Prescription Drug - Generic

$1

—

69097097307

FOSINOPRIL-HYDROCHLOROTHIAZIDE 20-12.5 MG TAB

Prescription Drug - Generic

$0

—

69097097407

MEPROBAMATE 200 MG TABLET

Prescription Drug - Generic

$5

—

69097097507

MEPROBAMATE 400 MG TABLET

Prescription Drug - Generic

$6

—

69097099807

METAXALONE 400 MG TABLET

Prescription Drug - Generic

$3

—

69100

Biopsy of external ear

Surgery - Auditory

$37

—

69102010201

ROWEEPRA 750 MG TABLET

Prescription Drug - Generic

$0

—

69102010301

ROWEEPRA 1,000 MG TABLET

Prescription Drug - Generic

$0

—

69102010501

ROWEEPRA 500 MG TABLET

Prescription Drug - Generic

$0

—

69102015006

SUBVENITE 150 MG TABLET

Prescription Drug - Generic

$0

—

69102020060

ROWEEPRA XR 500 MG TABLET

Prescription Drug - Generic

$0

—

69102020160

ROWEEPRA XR 750 MG TABLET

Prescription Drug - Generic

$1

—

69102030101

SUBVENITE 25 MG TABLET

Prescription Drug - Generic

$0

—

69102031901

SUBVENITE 100 MG TABLET

Prescription Drug - Generic

$0

—

69102032001

SUBVENITE 200 MG TABLET

Prescription Drug - Generic

$0

—

69105

Biopsy of external ear canal

Surgery - Auditory

$57

—

69110

Remove external ear partial

Surgery - Auditory

$301

—

69120

Removal of external ear

Surgery - Auditory

$361

—

69140

Remove ear canal lesion(s)

Surgery - Auditory

$843

—

69145

Remove ear canal lesion(s)

Surgery - Auditory

$237

—

69150

Extensive ear canal surgery

Surgery - Auditory

$900

—

69155

Extensive ear/neck surgery

Surgery - Auditory

$1,431

—

69200

Clear outer ear canal

Surgery - Auditory

$42

—

69205

Clear outer ear canal

Surgery - Auditory

$88

—

69209

Remove impacted ear wax uni

Surgery - Auditory

$17

—

My Cost List