Medical Procedure Costs

00642007030

VITAFOL-ONE CAPSULE

Prescription Drug - Brand

$4

—

00642007530

SELECT-OB + DHA PACK

Prescription Drug - Brand

$2

—

00642007630

VITAFOL-OB+DHA COMBO PACK

Prescription Drug - Brand

$2

—

00642007912

VITAFOL-OB CAPLET

Prescription Drug - Brand

$4

—

00642009330

VITAFOL ULTRA SOFTGEL

Prescription Drug - Brand

$5

—

00642009430

VITAFOL NANO TABLET

Prescription Drug - Brand

$4

—

00642012590

VITAFOL GUMMIES

Prescription Drug - Brand

$2

—

00642020790

STROVITE ONE CAPLET

Prescription Drug - Brand

$3

—

00642301030

REAPHIRM CAPSULE

Prescription Drug - Brand

$3

—

00642746605

NUVESSA VAGINAL 1.3% GEL

Prescription Drug - Brand

$43

—

00642747002

SLYND 4 MG TABLET

Prescription Drug - Brand

$7

—

00642747101

TYBLUME 0.1-0.02 MG CHEW TAB

Prescription Drug - Brand

$1

—

00642747330

VITAFOL FE PLUS SOFTGEL

Prescription Drug - Brand

$5

—

0064U

Antibody testing for syphilis

Pathology/Laboratory

$31

—

0065U

Non-antibody testing for syphilis

Pathology/Laboratory

$18

—

0067U

Protein expression profiling of 4 biomarkers of breast cancer in precancerous

Pathology/Laboratory

$1,897

—

00682005130

CROTAN 10% LOTION

Prescription Drug - Generic

$3

—

00682047516

MAR-COF CG LIQUID

Prescription Drug - Generic

$0

—

00682080401

MARGESIC CAPSULE

Prescription Drug - Generic

$2

—

00682300101

BACMIN CAPLET

Prescription Drug - Generic

$1

—

0068U

Detection of Candida species by amplified probe

Pathology/Laboratory

$143

—

0069U

mRNA expression profiling of miR-31-3 in colon tumor tissue

Pathology/Laboratory

$380

—

00703001801

HYDROMORPHONE 10 MG/ML VIAL

Prescription Drug - Generic

$3

—

0070U

Gene analysis (cytochrome P450, family 2, subfamily D, polypeptide 6) for

Pathology/Laboratory

$676

—

00713010125

SANI-SUPP ADULT SUPPOSITORY

Prescription Drug - Generic

$0

—

00713010225

SANI-SUPP PEDIATRIC SUPPOS

Prescription Drug - Generic

$0

—

00713010950

BISAC-EVAC 10 MG SUPPOSITORY

Prescription Drug - Generic

$0

—

00713011812

ACEPHEN 120 MG SUPPOSITORY

Prescription Drug - Generic

$0

—

00713013212

PROMETHEGAN 50 MG SUPPOSITORY

Prescription Drug - Generic

$25

—

00713013512

PROCHLORPERAZINE 25 MG SUPP

Prescription Drug - Generic

$6

—

00713016412

ACEPHEN 325 MG SUPPOSITORY

Prescription Drug - Generic

$1

—

00713016501

ACEPHEN 650 MG SUPPOSITORY

Prescription Drug - Generic

$0

—

00713019757

MICONAZOLE 100 MG VAG SUPP

Prescription Drug - Generic

$1

—

00713029531

ALLERGY 2% CREAM

Prescription Drug - Generic

$0

—

00713029832

FORMULATION R OINTMENT

Prescription Drug - Generic

$0

—

00713031853

CALCIPOTRIENE 0.005% SOLUTION

Prescription Drug - Generic

$3

—

00713042560

DOCUSOFT S 100 MG CAPSULE

Prescription Drug - Generic

$0

—

00713052610

PROMETHEGAN 25 MG SUPP

Prescription Drug - Generic

$8

—

00713052612

PROMETHEGAN 25 MG SUPPOSITORY

Prescription Drug - Generic

$2

—

00713053612

PROMETHEGAN 12.5 MG SUPPOS

Prescription Drug - Generic

$2

—

00713059377

MICONAZOLE 3-DAY COMBO PACK

Prescription Drug - Generic

$8

—

00713086030

BENICAR 5 MG TABLET

Prescription Drug - Brand

$9

—

00713086130

BENICAR 20 MG TABLET

Prescription Drug - Brand

$11

—

00713086230

BENICAR 40 MG TABLET

Prescription Drug - Brand

$16

—

00713086330

BENICAR HCT 20-12.5 MG TABLET

Prescription Drug - Brand

$11

—

00713086430

BENICAR HCT 40-12.5 MG TABLET

Prescription Drug - Brand

$16

—

00713086530

BENICAR HCT 40-25 MG TABLET

Prescription Drug - Brand

$16

—

00713087030

AZOR 5-20 MG TABLET

Prescription Drug - Brand

$14

—

00713087230

AZOR 5-40 MG TABLET

Prescription Drug - Brand

$18

—

00713087330

AZOR 10-40 MG TABLET

Prescription Drug - Brand

$18

—

My Cost List