Medical Procedure Costs

69238199301

ASA-BUTALB-CAFF-COD #3 CAPSULE

Prescription Drug - Generic

$1

—

69238202708

SPIRONOLACTONE 25 MG/5 ML SUSP

Prescription Drug - Generic

$2

—

69238202905

MUPIROCIN 2% CREAM

Prescription Drug - Generic

$1

—

69238210407

NALOXONE HCL 4 MG NASAL SPRAY

Prescription Drug - Generic

$15

—

69238212209

PREDNISOLONE 15 MG/5 ML SOLN

Prescription Drug - Generic

$0

—

69238226107

VANCOMYCIN 250 MG/5 ML ORAL SOL

Prescription Drug - Generic

$1

—

69238235206

ZOLMITRIPTAN 5 MG NASAL SPRAY

Prescription Drug - Generic

$40

—

69238254803

TASIMELTEON 20 MG CAPSULE

Prescription Drug - Generic

$400

—

69238267301

AMLODIPINE-OLMESARTAN 10-20 MG

Prescription Drug - Generic

$0

—

69238267401

AMLODIPINE-OLMESARTAN 10-40 MG

Prescription Drug - Generic

$0

—

69238267501

AMLODIPINE-OLMESARTAN 5-20 MG

Prescription Drug - Generic

$0

—

69238267601

AMLODIPINE-OLMESARTAN 5-40 MG

Prescription Drug - Generic

$0

—

69238269201

NICARDIPINE 30 MG CAPSULE

Prescription Drug - Generic

$4

—

69292026501

PILOCARPINE HCL 5 MG TABLET

Prescription Drug - Generic

$0

—

69292051450

CEFPODOXIME 100 MG TABLET

Prescription Drug - Generic

$1

—

69292051650

CEFPODOXIME 200 MG TABLET

Prescription Drug - Generic

$1

—

69292052210

CAPTOPRIL 12.5 MG TABLET

Prescription Drug - Generic

$0

—

69292052410

CAPTOPRIL 25 MG TABLET

Prescription Drug - Generic

$0

—

69292052610

CAPTOPRIL 50 MG TABLET

Prescription Drug - Generic

$0

—

69292052801

CAPTOPRIL 100 MG TABLET

Prescription Drug - Generic

$0

—

69292054010

ENALAPRIL MALEATE 2.5 MG TAB

Prescription Drug - Generic

$0

—

69292054210

ENALAPRIL MALEATE 5 MG TABLET

Prescription Drug - Generic

$0

—

69292054410

ENALAPRIL MALEATE 10 MG TAB

Prescription Drug - Generic

$0

—

69292054601

ENALAPRIL MALEATE 20 MG TAB

Prescription Drug - Generic

$0

—

69292060560

DIGOXIN 0.05 MG/ML SOLUTION

Prescription Drug - Generic

$1

—

69292072225

FLURBIPROFEN 0.03% EYE DROP

Prescription Drug - Generic

$10

—

69300

Revise external ear

Surgery - Auditory

$427

—

69310

Rebuild outer ear canal

Surgery - Auditory

$1,037

—

69315015510

HYDROCHLOROTHIAZIDE 12.5 MG TB

Prescription Drug - Generic

$0

—

69315016350

DOXEPIN 150 MG CAPSULE

Prescription Drug - Generic

$0

—

69315018403

LEUCOVORIN CALCIUM 5 MG TAB

Prescription Drug - Generic

$0

—

69315018524

LEUCOVORIN CALCIUM 10 MG TAB

Prescription Drug - Generic

$2

—

69315018624

LEUCOVORIN CALCIUM 15 MG TAB

Prescription Drug - Generic

$2

—

69315018725

LEUCOVORIN CALCIUM 25 MG TAB

Prescription Drug - Generic

$2

—

69315021101

NIFEDIPINE 10 MG CAPSULE

Prescription Drug - Generic

$0

—

69315021201

NIFEDIPINE 20 MG CAPSULE

Prescription Drug - Generic

$1

—

69315027520

DICLOFENAC POTASSIUM 25 MG CAP

Prescription Drug - Generic

$3

—

69315028109

FENOFIBRIC ACID DR 45 MG CAP

Prescription Drug - Generic

$0

—

69315028209

FENOFIBRIC ACID DR 135 MG CAP

Prescription Drug - Generic

$0

—

69315030130

RECTASMOOTHE 5% CREAM

Prescription Drug - Generic

$0

—

69315031228

PROCTO-MED HC 2.5% CREAM

Prescription Drug - Generic

$0

—

69315033102

GATIFLOXACIN 0.5% EYE DROPS

Prescription Drug - Generic

$10

—

69315040358

VARENICLINE 1 MG CONT MONTH BX

Prescription Drug - Generic

$0

—

69315050460

NYSTATIN 100,000 UNIT/ML SUSP

Prescription Drug - Generic

$0

—

69315050609

DICLOFENAC POT 50 MG POWDR PKT

Prescription Drug - Generic

$16

—

69315090410

LORAZEPAM 0.5 MG TABLET

Prescription Drug - Generic

$0

—

69315090510

LORAZEPAM 1 MG TABLET

Prescription Drug - Generic

$0

—

69315090610

LORAZEPAM 2 MG TABLET

Prescription Drug - Generic

$0

—

69315091101

OXAZEPAM 10 MG CAPSULE

Prescription Drug - Generic

$1

—

69315091201

OXAZEPAM 15 MG CAPSULE

Prescription Drug - Generic

$1

—

My Cost List