Medical Procedure Costs

00378443001

FLURAZEPAM 30 MG CAPSULE

Prescription Drug - Generic

$1

—

00378464316

ESTRADIOL 0.0375 MG PATCH

Prescription Drug - Generic

$8

—

00378516893

LAMIVUDINE 100 MG TABLET

Prescription Drug - Generic

$4

—

00378520001

TOLMETIN SODIUM 400 MG CAP

Prescription Drug - Generic

$2

—

00378528001

DILTIAZEM ER 180 MG CAPSULE

Prescription Drug - Generic

$1

—

00378534005

DILTIAZEM ER 240 MG CAPSULE

Prescription Drug - Generic

$1

—

00378615149

MENTAX 1% CREAM

Prescription Drug - Brand

$6

—

00378638001

VERAPAMIL ER 180 MG CAPSULE

Prescription Drug - Generic

$2

—

00378644001

VERAPAMIL ER 240 MG CAPSULE

Prescription Drug - Generic

$3

—

00378655085

LEVONOR-ETH ESTRAD 0.15-0.03

Prescription Drug - Generic

$0

—

00378661193

AMNESTEEM 10 MG CAPSULE

Prescription Drug - Generic

$2

—

00378661293

AMNESTEEM 20 MG CAPSULE

Prescription Drug - Generic

$2

—

00378661393

AMNESTEEM 30 MG CAPSULE

Prescription Drug - Generic

$2

—

00378661493

AMNESTEEM 40 MG CAPSULE

Prescription Drug - Generic

$2

—

00378662993

EPROSARTAN MESYLATE 600 MG TAB

Prescription Drug - Generic

$3

—

00378699393

LEVALBUTEROL CONC 1.25 MG/0.5

Prescription Drug - Generic

$4

—

00378727485

NORETHIN-EE 1.5-0.03 MG(21) TB

Prescription Drug - Generic

$0

—

00378728285

DESOGEST-ETH ESTRA 0.15-0.03 MG

Prescription Drug - Generic

$0

—

00378728353

NORETH-ESTRAD-FE 1-0.02(21)-75

Prescription Drug - Generic

$0

—

00378728385

NORETH-EE-FE 1-0.02(21)-75 TAB

Prescription Drug - Generic

$0

—

00378728490

LEVONO-E ESTRAD 0.10-0.02-0.01

Prescription Drug - Generic

$0

—

00378728590

LEVONO-E ESTRAD 0.15-0.03-0.01

Prescription Drug - Generic

$0

—

00378728885

NORETH-EE-FE 1.5-0.03 MG(21)-75

Prescription Drug - Generic

$0

—

00378729653

DESOGESTR-ETH ESTRAD ETH ESTRA

Prescription Drug - Generic

$0

—

00378729785

NORET-ESTR-FE 0.4-0.035(21)-75

Prescription Drug - Generic

$0

—

00378730153

NORETHIN-ESTRAD-FERR 1-0.02 MG

Prescription Drug - Generic

$2

—

00378730385

NORETH-EE-FE 1 MG/20-30-35 MCG

Prescription Drug - Generic

$1

—

00378730685

ETHYNODIOL-ETH ESTRA 1 MG-50 MCG

Prescription Drug - Generic

$1

—

00378730785

ETHYNODIOL-ETH ESTRA 1 MG-35 MCG

Prescription Drug - Generic

$0

—

00378730885

NORETHIN-ESTRA-FE 0.8-0.025 MG

Prescription Drug - Generic

$2

—

00378731685

LEVONORG 0.15 MG-EE 20-25-30 MCG

Prescription Drug - Generic

$1

—

00378750232

BREYNA 80-4.5 MCG INHALER

Prescription Drug - Generic

$20

—

00378750332

BREYNA 160-4.5 MCG INHALER

Prescription Drug - Generic

$23

—

00378802093

FLUVASTATIN SODIUM 20 MG CAP

Prescription Drug - Generic

$3

—

00378802193

FLUVASTATIN SODIUM 40 MG CAP

Prescription Drug - Generic

$3

—

00378809045

TRETINOIN 0.05% GEL

Prescription Drug - Generic

$4

—

00378820001

KETOPROFEN ER 200 MG CAPSULE

Prescription Drug - Generic

$6

—

00378822250

MICONAZOLE-ZINC-PETRO 0.25-15%

Prescription Drug - Generic

$9

—

00378868854

CLINDAMYCIN-BENZOYL PEROX GEL

Prescription Drug - Generic

$6

—

00378932032

WIXELA 100-50 INHUB

Prescription Drug - Generic

$1

—

00378932132

WIXELA 250-50 INHUB

Prescription Drug - Generic

$1

—

00378932232

WIXELA 500-50 INHUB

Prescription Drug - Generic

$2

—

00378972055

DENAVIR 1% CREAM

Prescription Drug - Brand

$155

—

0037U

DNA gene analysis of 324 genes in solid organ tumor tissue

Pathology/Laboratory

$3,500

—

0038U

Measurement of vitamin D in serum

Pathology/Laboratory

$30

—

0039U

Testing for anti-DNA antibody

Pathology/Laboratory

$14

—

00406009203

DEPADE 50 MG TABLET

Prescription Drug - Generic

$1

—

00406012301

HYDROCODON-ACETAMINOPHEN 5-325

Prescription Drug - Generic

$0

—

00406112110

METHYLIN 5 MG TABLET

Prescription Drug - Generic

$1

—

00406112210

METHYLIN 10 MG TABLET

Prescription Drug - Generic

$1

—

My Cost List