Medical Procedure Costs

13517010030

DIAZOXIDE 50 MG/ML ORAL SUSP

Prescription Drug - Generic

$7

—

13548001206

SALEX 6% SHAMPOO

Prescription Drug - Brand

$1

—

13548003025

AKNE-MYCIN 2% OINTMENT

Prescription Drug - Brand

$5

—

13548007045

ATRALIN 0.05% GEL

Prescription Drug - Brand

$12

—

13548013250

ACANYA GEL PUMP

Prescription Drug - Brand

$10

—

13551010105

KARBINAL ER 4 MG/ 5 ML SUSP

Prescription Drug - Brand

$1

—

13668010501

ISOSORBIDE MN ER 60 MG TABLET

Prescription Drug - Generic

$0

—

13811000710

TRINATAL RX 1 TABLET

Prescription Drug - Generic

$0

—

13811001030

COMPLETE NATAL DHA

Prescription Drug - Generic

$0

—

13811001290

FERRAPLUS 90 TABLET

Prescription Drug - Generic

$0

—

13811001490

COMPLETENATE TABLET CHEW

Prescription Drug - Generic

$0

—

13811002710

ELITE-OB CAPLET

Prescription Drug - Generic

$1

—

13811004930

ULTIMATECARE ONE CAPSULE

Prescription Drug - Generic

$1

—

13811006816

TL-HIST DM LIQUID

Prescription Drug - Generic

$0

—

13811007716

TL-DMX SYRUP

Prescription Drug - Generic

$0

—

13811008330

TL-HIST PD DROPS

Prescription Drug - Generic

$2

—

13811008516

MESEHIST DM LIQUID

Prescription Drug - Generic

$0

—

13811050460

TL G-FOL OS TABLET

Prescription Drug - Generic

$0

—

13811051510

VOL-CARE RX TABLET

Prescription Drug - Generic

$0

—

13811051690

VOL-TAB RX TABLET

Prescription Drug - Generic

$0

—

13811051810

TRIGELS-F FORTE SOFTGEL

Prescription Drug - Generic

$0

—

13811051950

VOL-PLUS TABLET

Prescription Drug - Generic

$0

—

13811052501

TRIPHROCAPS SOFTGEL

Prescription Drug - Generic

$0

—

13811052701

TL GARD RX TABLET

Prescription Drug - Generic

$0

—

13811052860

TL ICON CAPSULE

Prescription Drug - Generic

$0

—

13811053010

TL-FLUORIVITE CHEWABLE TABLET

Prescription Drug - Generic

$1

—

13811053530

FOLIVANE-OB CAPSULE

Prescription Drug - Generic

$1

—

13811053630

TARON-C DHA CAPSULE

Prescription Drug - Generic

$1

—

13811053890

FOLIVANE-F CAPSULE

Prescription Drug - Generic

$0

—

13811053990

FOLIVANE-PLUS CAPSULE

Prescription Drug - Generic

$0

—

13811054330

TARON-PREX PRENATAL DHA CAP

Prescription Drug - Generic

$1

—

13811056701

TARON-CRYSTALS PACKET

Prescription Drug - Generic

$1

—

13811058030

ZATEAN-PN DHA CAPSULE

Prescription Drug - Generic

$1

—

13811058190

ZATEAN-PN TABLET

Prescription Drug - Generic

$1

—

13811058230

ZATEAN-PN PLUS SOFTGEL

Prescription Drug - Generic

$1

—

13811059830

VEMAVITE-PRX 2 CAPSULE

Prescription Drug - Generic

$1

—

13811061490

TRINATAL GT TABLET

Prescription Drug - Generic

$0

—

13811065710

HYDROCODONE-ACETAMINOPHEN 2.5-325 MG TABLET

Prescription Drug - Generic

$1

—

13811068930

TRAMADOL HCL ER 100 MG CAPSULE

Prescription Drug - Generic

$8

—

13811069030

TRAMADOL HCL ER 200 MG CAPSULE

Prescription Drug - Generic

$9

—

13811070030

METHYLPHENIDATE ER 63 MG TAB

Prescription Drug - Generic

$18

—

13811071130

METHYLPHENIDATE ER 45 MG TAB

Prescription Drug - Generic

$18

—

13913000616

GRALISE 30-DAY STARTER PACK

Prescription Drug - Brand

$8

—

13913000812

ZIPSOR 25 MG CAPSULE

Prescription Drug - Brand

$14

—

13913001203

CAMBIA 50 MG POWDER PACKET

Prescription Drug - Brand

$94

—

13925005010

SALICYLIC ACID 6% LOTION KIT

Prescription Drug - Generic

$0

—

13925011601

SE-NATAL-19 TABLET

Prescription Drug - Generic

$0

—

13925011701

SE-NATAL 19 CHEWABLE TABLET

Prescription Drug - Generic

$0

—

13925011890

SE-TAN PLUS CAPSULE

Prescription Drug - Generic

$0

—

13925016420

LIDOCAINE-HC 3-2.5% GEL KIT

Prescription Drug - Generic

$100

—

My Cost List