Medical Procedure Costs

00472088282

ACETASOL HC EAR DROPS

Prescription Drug - Generic

$7

—

00472103016

HYDROMET SYRUP

Prescription Drug - Generic

$0

—

00472120350

FEVERALL 650 MG SUPPOSITORY

Prescription Drug - Generic

$0

—

00472173803

MICONAZOLE 3 200 MG VAG SUPP

Prescription Drug - Generic

$14

—

00472524269

PERMETHRIN 1% LOTION

Prescription Drug - Generic

$0

—

0047U

mRNA gene analysis of 17 genes in prostate tumor tissue

Pathology/Laboratory

$3,873

—

00480012649

ICOSAPENT ETHYL 500 MG CAPSULE

Prescription Drug - Generic

$0

—

00480095258

NAPROXEN SOD ER 500 MG TABLET

Prescription Drug - Generic

$9

—

00480347224

AMETHYST 90-20 MCG TABLET

Prescription Drug - Generic

$1

—

00480400062

VESTURA 3 MG-0.02 MG TABLET

Prescription Drug - Generic

$0

—

00480725046

LIRAGLUTIDE 5-PAK 18 MG/3 ML

Prescription Drug - Generic

$71

—

00480927706

ALYQ 20 MG TABLET

Prescription Drug - Generic

$0

—

00480973401

RISPERIDONE ER 37.5 MG VIAL

Prescription Drug - Generic

$730

—

00482480014

ANAMANTLE HC CREAM

Prescription Drug - Generic

$2

—

00482480020

ANAMANTLE HC CREAM KIT

Prescription Drug - Generic

$194

—

00485008001

RYMED TABLET

Prescription Drug - Brand

$0

—

00485008201

ED-SPAZ 0.125 MG ODT

Prescription Drug - Generic

$0

—

00485008501

ED-CHLORTAN 4 MG TABLET

Prescription Drug - Generic

$0

—

00485009804

ED CHLORPED JR SYRUP

Prescription Drug - Generic

$0

—

00485015130

UROGESIC-BLUE TABLET

Prescription Drug - Generic

$4

—

00485015516

ED A-HIST LIQUID

Prescription Drug - Generic

$0

—

00485017116

ED-A-HIST DM LIQUID

Prescription Drug - Generic

$0

—

00485020216

RYNEX PE LIQUID

Prescription Drug - Generic

$0

—

00485020416

RYNEX DM LIQUID

Prescription Drug - Generic

$0

—

00485021001

ED-A-HIST PSE TABLET

Prescription Drug - Generic

$0

—

00485024001

ED A-HIST DM TABLET

Prescription Drug - Generic

$0

—

00485025001

MUCAPHED TABLET

Prescription Drug - Generic

$0

—

00485025401

ED-A-HIST 4 MG-10 MG TABLET

Prescription Drug - Generic

$0

—

00486111105

K-PHOS ORIGINAL TABLET

Prescription Drug - Generic

$1

—

00486112505

K-PHOS NEUTRAL TABLET

Prescription Drug - Generic

$0

—

00487278401

ASTHMANEFRIN RFILL 2.25% SOLN

Prescription Drug - Brand

$1

—

00487900360

SODIUM CHLORIDE 3% VIAL

Prescription Drug - Generic

$0

—

00487900760

SODIUM CHLORIDE 7% VIAL

Prescription Drug - Generic

$0

—

00487930133

SODIUM CHLORIDE 0.9% INHAL VL

Prescription Drug - Generic

$0

—

0048U

DNA gene analysis of 468 genes in solid organ tumor tissue

Pathology/Laboratory

$2,920

—

0049U

Gene analysis (nucleophosmin)

Pathology/Laboratory

$407

—

0050U

DNA gene analysis of targeted sequences in 194 genes for acute myelogenous

Pathology/Laboratory

$2,917

—

00517072001

BETAMETHASONE AC-SP 6 MG/ML VL

Prescription Drug - Generic

$8

—

00517079901

BETAMETHASONE SP-AC 30 MG/5 ML

Prescription Drug - Generic

$9

—

00517231005

VENOFER 200 MG/10 ML VIAL

Prescription Drug - Brand

$13

—

00517888005

SPRIX 15.75 MG NASAL SPRAY

Prescription Drug - Brand

$184

—

0051U

Testing for presence of 31 prescription drugs in urine or blood specimen

Pathology/Laboratory

$247

—

00527131201

BUTALBITAL COMP-CODEINE #3 CAP

Prescription Drug - Generic

$1

—

00527132410

DIGOX 125 MCG TABLET

Prescription Drug - Generic

$0

—

00527132510

DIGOX 250 MCG TABLET

Prescription Drug - Generic

$0

—

00527142536

MORPHINE SULF 100 MG/5 ML (20 MG/ML) SOLUTION

Prescription Drug - Generic

$0

—

00527142636

OXYCODONE CONC 20 MG/ML SOLN

Prescription Drug - Generic

$6

—

00527169801

CODEINE SULFATE 30 MG TABLET

Prescription Drug - Generic

$1

—

00527192736

METHADONE 10 MG/ML ORAL CONC

Prescription Drug - Generic

$1

—

00527457937

METHYLPHENIDATE CD 10 MG CAP

Prescription Drug - Generic

$1

—

My Cost List