Medical Procedure Costs

69367036960

RISPERIDONE 0.5 MG TABLET

Prescription Drug - Generic

$0

—

69367037060

RISPERIDONE 1 MG TABLET

Prescription Drug - Generic

$0

—

69367037160

RISPERIDONE 2 MG TABLET

Prescription Drug - Generic

$0

—

69367037260

RISPERIDONE 3 MG TABLET

Prescription Drug - Generic

$0

—

69367037360

RISPERIDONE 4 MG TABLET

Prescription Drug - Generic

$0

—

69367038501

CIPROFLOXACIN HCL 250 MG TAB

Prescription Drug - Generic

$0

—

69367038605

CIPROFLOXACIN HCL 500 MG TAB

Prescription Drug - Generic

$0

—

69367038750

CIPROFLOXACIN HCL 750 MG TAB

Prescription Drug - Generic

$0

—

69367039785

LIDOCAINE-HC 3-0.5% CREAM

Prescription Drug - Generic

$1

—

69367039816

PYRILAMINE DM 7.5 MG-7.5 MG/5 ML

Prescription Drug - Generic

$0

—

69367041260

METFORMIN ER 500 MG OSMOTIC TB

Prescription Drug - Generic

$0

—

69367041360

METFORMIN ER 1,000 MG OSM-TAB

Prescription Drug - Generic

$0

—

69367041401

THEOPHYLLINE ER 400 MG TABLET

Prescription Drug - Generic

$1

—

69367041601

BUTALBITAL-ASPIRIN-CAFFEINE 50-325-40 MG CAPSULE

Prescription Drug - Generic

$1

—

69367041901

CARISOPRODOL 250 MG TABLET

Prescription Drug - Generic

$0

—

69367061501

SALSALATE 500 MG TABLET

Prescription Drug - Generic

$0

—

69367061601

SALSALATE 750 MG TABLET

Prescription Drug - Generic

$0

—

69420

Incision of eardrum

Surgery - Auditory

$111

—

69421

Incision of eardrum

Surgery - Auditory

$138

—

69424

Remove ventilating tube

Surgery - Auditory

$55

—

69433

Create eardrum opening

Surgery - Auditory

$120

—

69436

Create eardrum opening

Surgery - Auditory

$145

—

69440

Exploration of middle ear

Surgery - Auditory

$624

—

69450

Eardrum revision

Surgery - Auditory

$497

—

69452010619

MONTELUKAST SOD 4 MG TAB CHEW

Prescription Drug - Generic

$0

—

69452010719

MONTELUKAST SOD 5 MG TAB CHEW

Prescription Drug - Generic

$0

—

69452011645

CLOBAZAM 2.5 MG/ML SUSPENSION

Prescription Drug - Generic

$0

—

69452012760

SEVELAMER 2.4 GM POWDER PACKET

Prescription Drug - Generic

$1

—

69452014330

BENZONATATE 100 MG CAPSULE

Prescription Drug - Generic

$0

—

69452014430

BENZONATATE 200 MG CAPSULE

Prescription Drug - Generic

$0

—

69452014513

PARICALCITOL 1 MCG CAPSULE

Prescription Drug - Generic

$1

—

69452014613

PARICALCITOL 2 MCG CAPSULE

Prescription Drug - Generic

$2

—

69452015020

VALPROIC ACID 250 MG CAPSULE

Prescription Drug - Generic

$0

—

69452015120

VITAMIN D2 1.25 MG(50,000 UNIT)

Prescription Drug - Generic

$0

—

69452015220

ETHOSUXIMIDE 250 MG CAPSULE

Prescription Drug - Generic

$0

—

69452015520

TACROLIMUS 5 MG CAPSULE

Prescription Drug - Generic

$3

—

69452015674

RIZATRIPTAN 5 MG ODT

Prescription Drug - Generic

$0

—

69452015774

RIZATRIPTAN 10 MG ODT

Prescription Drug - Generic

$1

—

69452015825

COLESEVELAM 625 MG TABLET

Prescription Drug - Generic

$0

—

69452017173

AZITHROMYCIN 250 MG TABLET

Prescription Drug - Generic

$0

—

69452017274

AZITHROMYCIN 500 MG TABLET

Prescription Drug - Generic

$1

—

69452017313

AZITHROMYCIN 600 MG TABLET

Prescription Drug - Generic

$1

—

69452018213

FLUVOXAMINE ER 100 MG CAPSULE

Prescription Drug - Generic

$5

—

69452018313

FLUVOXAMINE ER 150 MG CAPSULE

Prescription Drug - Generic

$5

—

69452020720

CALCITRIOL 0.25 MCG CAPSULE

Prescription Drug - Generic

$0

—

69452020820

CALCITRIOL 0.5 MCG CAPSULE

Prescription Drug - Generic

$0

—

69452020920

NIMODIPINE 30 MG CAPSULE

Prescription Drug - Generic

$1

—

69452025422

ETRAVIRINE 100 MG TABLET

Prescription Drug - Generic

$8

—

69452025517

ETRAVIRINE 200 MG TABLET

Prescription Drug - Generic

$11

—

69452028820

FLUVOXAMINE MALEATE 50 MG TAB

Prescription Drug - Generic

$0

—

My Cost List