Medical Procedure Costs

72888015405

CLONAZEPAM 2 MG TABLET

Prescription Drug - Generic

$0

—

72888015530

CARBIDOPA-LEVO ER 25-100 TAB

Prescription Drug - Generic

$0

—

72888015630

CARBIDOPA-LEVO ER 50-200 TAB

Prescription Drug - Generic

$0

—

72888015739

NORTRIPTYLINE 10 MG/5 ML SOLN

Prescription Drug - Generic

$0

—

72888016230

TRAMADOL HCL 25 MG TABLET

Prescription Drug - Generic

$3

—

72888017246

LITHIUM 8 MEQ/5 ML SOLUTION

Prescription Drug - Generic

$0

—

72888017348

HALOPERIDOL LAC 2 MG/ML CONC

Prescription Drug - Generic

$0

—

72888017530

DESVENLAFAXINE SUCCNT ER 25 MG

Prescription Drug - Generic

$0

—

72888018230

BUPRENORPHINE 2 MG TABLET SL

Prescription Drug - Generic

$0

—

72888018330

BUPRENORPHINE 8 MG TABLET SL

Prescription Drug - Generic

$1

—

72888018505

MYCOPHENOLATE 500 MG TABLET

Prescription Drug - Generic

$0

—

72888019205

MYCOPHENOLATE 250 MG CAPSULE

Prescription Drug - Generic

$0

—

72888019912

MYCOPHENOLIC ACID DR 180 MG TB

Prescription Drug - Generic

$0

—

72888020012

MYCOPHENOLIC ACID DR 360 MG TB

Prescription Drug - Generic

$0

—

72888020805

METOPROLOL TARTRATE 25 MG TAB

Prescription Drug - Generic

$0

—

72888021002

METOPROLOL TARTRATE 50 MG TAB

Prescription Drug - Generic

$0

—

72888021201

METOPROLOL TARTRATE 100 MG TAB

Prescription Drug - Generic

$0

—

72888022001

BENAZEPRIL-HYDROCHLOROTHIAZIDE 10-12.5 MG TAB

Prescription Drug - Generic

$0

—

72888022101

BENAZEPRIL-HYDROCHLOROTHIAZIDE 20-12.5 MG TAB

Prescription Drug - Generic

$0

—

72888022201

BENAZEPRIL-HYDROCHLOROTHIAZIDE 20-25 MG TAB

Prescription Drug - Generic

$0

—

72888022401

GUANFACINE HCL ER 1 MG TABLET

Prescription Drug - Generic

$0

—

72888022501

GUANFACINE HCL ER 2 MG TABLET

Prescription Drug - Generic

$0

—

72888022601

GUANFACINE HCL ER 3 MG TABLET

Prescription Drug - Generic

$0

—

72888022701

GUANFACINE HCL ER 4 MG TABLET

Prescription Drug - Generic

$0

—

72888023501

DEXAMETHASONE 0.5 MG TABLET

Prescription Drug - Generic

$0

—

72888023601

DEXAMETHASONE 0.75 MG TABLET

Prescription Drug - Generic

$0

—

72888023701

DEXAMETHASONE 1 MG TABLET

Prescription Drug - Generic

$0

—

72888023801

DEXAMETHASONE 1.5 MG TABLET

Prescription Drug - Generic

$0

—

72888023901

DEXAMETHASONE 2 MG TABLET

Prescription Drug - Generic

$0

—

72888024001

DEXAMETHASONE 4 MG TABLET

Prescription Drug - Generic

$0

—

72888024101

DEXAMETHASONE 6 MG TABLET

Prescription Drug - Generic

$0

—

72888046002

OXCARBAZEPINE 300 MG TABLET

Prescription Drug - Generic

$0

—

72888046102

OXCARBAZEPINE 600 MG TABLET

Prescription Drug - Generic

$0

—

72888046202

OXCARBAZEPINE 150 MG TABLET

Prescription Drug - Generic

$0

—

72888046602

BACLOFEN 10 MG/5 ML SOLUTION

Prescription Drug - Generic

$2

—

72888046801

LABETALOL HCL 300 MG TABLET

Prescription Drug - Generic

$0

—

72912052530

ADHANSIA XR 25 MG CAPSULE

Prescription Drug - Brand

$11

—

72912053530

ADHANSIA XR 35 MG CAPSULE

Prescription Drug - Brand

$11

—

72912054530

ADHANSIA XR 45 MG CAPSULE

Prescription Drug - Brand

$11

—

72912055530

ADHANSIA XR 55 MG CAPSULE

Prescription Drug - Brand

$11

—

72912057030

ADHANSIA XR 70 MG CAPSULE

Prescription Drug - Brand

$11

—

72912058530

ADHANSIA XR 85 MG CAPSULE

Prescription Drug - Brand

$11

—

72974041501

MYFEMBREE 40 MG-1 MG-0.5 MG TB

Prescription Drug - Brand

$45

—

72989037230

PROMETRIUM 100 MG CAPSULE

Prescription Drug - Brand

$16

—

72989037330

PROMETRIUM 200 MG CAPSULE

Prescription Drug - Brand

$30

—

72989040930

PHENDIMETRAZINE ER 105 MG CAP

Prescription Drug - Generic

$3

—

72989041710

LEVORPHANOL 2 MG TABLET

Prescription Drug - Generic

$11

—

73000

X-ray exam of collar bone

Radiology

$33

—

73010

X-ray exam of shoulder blade

Radiology

$25

—

73020

X-ray exam of shoulder

Radiology

$22

—

My Cost List