Medical Procedure Costs

69452029030

ACYCLOVIR 400 MG TABLET

Prescription Drug - Generic

$0

—

69452029130

ACYCLOVIR 800 MG TABLET

Prescription Drug - Generic

$0

—

69452032320

CIMETIDINE 200 MG TABLET

Prescription Drug - Generic

$0

—

69452032420

CIMETIDINE 300 MG TABLET

Prescription Drug - Generic

$0

—

69452032520

CIMETIDINE 400 MG TABLET

Prescription Drug - Generic

$0

—

69452032620

CIMETIDINE 800 MG TABLET

Prescription Drug - Generic

$1

—

69452033020

TERAZOSIN 1 MG CAPSULE

Prescription Drug - Generic

$0

—

69452033132

TERAZOSIN 2 MG CAPSULE

Prescription Drug - Generic

$0

—

69452033232

TERAZOSIN 5 MG CAPSULE

Prescription Drug - Generic

$0

—

69452033320

TERAZOSIN 10 MG CAPSULE

Prescription Drug - Generic

$0

—

69452033443

AMOX-CLAV 200-28.5 MG/5 ML SUS

Prescription Drug - Generic

$0

—

69452033543

AMOX-CLAV 400-57 MG/5 ML SUSP

Prescription Drug - Generic

$0

—

69452033611

AMOX-CLAV 500-125 MG TABLET

Prescription Drug - Generic

$0

—

69452034172

NARATRIPTAN HCL 2.5 MG TABLET

Prescription Drug - Generic

$1

—

69452034472

SUMATRIPTAN SUCC 25 MG TABLET

Prescription Drug - Generic

$0

—

69452034572

SUMATRIPTAN SUCC 50 MG TABLET

Prescription Drug - Generic

$0

—

69452034672

SUMATRIPTAN SUCC 100 MG TABLET

Prescription Drug - Generic

$0

—

69452034713

ESZOPICLONE 1 MG TABLET

Prescription Drug - Generic

$0

—

69452034820

ESZOPICLONE 2 MG TABLET

Prescription Drug - Generic

$0

—

69452034920

ESZOPICLONE 3 MG TABLET

Prescription Drug - Generic

$0

—

69452035092

GRANISETRON HCL 1 MG TABLET

Prescription Drug - Generic

$1

—

69452035120

TERBINAFINE HCL 250 MG TABLET

Prescription Drug - Generic

$0

—

69452035325

ACAMPROSATE CALC DR 333 MG TAB

Prescription Drug - Generic

$1

—

69452035620

ROPINIROLE HCL 0.25 MG TABLET

Prescription Drug - Generic

$0

—

69452035720

ROPINIROLE HCL 0.5 MG TABLET

Prescription Drug - Generic

$0

—

69452035820

ROPINIROLE HCL 1 MG TABLET

Prescription Drug - Generic

$0

—

69452035920

ROPINIROLE HCL 2 MG TABLET

Prescription Drug - Generic

$0

—

69452036020

ROPINIROLE HCL 3 MG TABLET

Prescription Drug - Generic

$0

—

69452036120

ROPINIROLE HCL 4 MG TABLET

Prescription Drug - Generic

$0

—

69452036220

ROPINIROLE HCL 5 MG TABLET

Prescription Drug - Generic

$0

—

69452036420

ZALEPLON 5 MG CAPSULE

Prescription Drug - Generic

$0

—

69452036520

ZALEPLON 10 MG CAPSULE

Prescription Drug - Generic

$0

—

69452037874

IBANDRONATE SODIUM 150 MG TAB

Prescription Drug - Generic

$3

—

69452038088

METFORMIN HCL 500 MG/5 ML SOLN

Prescription Drug - Generic

$0

—

69452043330

DIVALPROEX SOD DR 125 MG TAB

Prescription Drug - Generic

$0

—

69452043430

DIVALPROEX SOD DR 250 MG TAB

Prescription Drug - Generic

$0

—

69452043530

DIVALPROEX SOD DR 500 MG TAB

Prescription Drug - Generic

$0

—

69452043619

NICARDIPINE 20 MG CAPSULE

Prescription Drug - Generic

$1

—

69452045420

FLUVOXAMINE MALEATE 25 MG TAB

Prescription Drug - Generic

$0

—

69452045520

FLUVOXAMINE MALEATE 100 MG TAB

Prescription Drug - Generic

$0

—

69501

Mastoidectomy

Surgery - Auditory

$636

—

69502

Mastoidectomy

Surgery - Auditory

$840

—

69505

Remove mastoid structures

Surgery - Auditory

$1,128

—

69511

Extensive mastoid surgery

Surgery - Auditory

$1,153

—

69530

Extensive mastoid surgery

Surgery - Auditory

$1,522

—

69535

Remove part of temporal bone

Surgery - Auditory

$2,364

—

69536016288

PLAN B ONE-STEP 1.5 MG TABLET

Prescription Drug - Brand

$33

—

69536018112

ST. JOSEPH ASPIRIN EC 81 MG TB

Prescription Drug - Generic

$0

—

69536028136

ST. JOSEPH ASPIRIN 81 MG CHEW

Prescription Drug - Generic

$0

—

69536042524

BRONKAID DUAL ACTION CAPLET

Prescription Drug - Brand

$0

—

My Cost List