Medical Procedure Costs

16571069101

CARBIDOPA-LEVODOPA-ENTACAPONE 25-100-200 MG TAB

Prescription Drug - Generic

$1

—

16571069201

CARBIDOPA-LEVODOPA-ENTACAPONE 31.25-125-200 MG TAB

Prescription Drug - Generic

$1

—

16571069301

CARBIDOPA-LEVODOPA-ENTACAPONE 37.5-150-200 MG TAB

Prescription Drug - Generic

$1

—

16571069401

CARBIDOPA-LEVODOPA-ENTACAPONE 50-200-200 MG TAB

Prescription Drug - Generic

$1

—

16571072360

SULFAMYLON 8.5% CREAM

Prescription Drug - Brand

$1

—

16571080901

QUETIAPINE 150 MG TABLET

Prescription Drug - Generic

$1

—

16571082310

DENTA 5000 PLUS SENSITIV PASTE

Prescription Drug - Generic

$0

—

16571083110

PROBENECID 500 MG TABLET

Prescription Drug - Generic

$1

—

16714034004

LEVONEST-28 TABLET

Prescription Drug - Generic

$0

—

16714034604

DASETTA 7/7/7-28 TABLET

Prescription Drug - Generic

$0

—

16714034704

PHILITH 0.4-0.035 MG TABLET

Prescription Drug - Generic

$0

—

16714034804

DASETTA 1-35-28 TABLET

Prescription Drug - Generic

$0

—

16714035904

FALMINA-28 TABLET

Prescription Drug - Generic

$0

—

16714036004

MONO-LINYAH 28 TABLET

Prescription Drug - Generic

$0

—

16714036304

TRI-LINYAH TABLET

Prescription Drug - Generic

$0

—

16714036504

ELINEST-28 TABLET

Prescription Drug - Generic

$0

—

16714036603

SETLAKIN 0.15 MG-0.03 MG TAB

Prescription Drug - Generic

$0

—

16714036704

DESOGESTREL-ETHINYL ESTRAD TAB

Prescription Drug - Generic

$0

—

16714037003

WERA 0.5/0.035 MG 28 TABLET

Prescription Drug - Generic

$0

—

16714040404

PIMTREA 28 DAY TABLET

Prescription Drug - Generic

$0

—

16714040504

LARIN FE 1.5-30 TABLET

Prescription Drug - Generic

$0

—

16714040604

LARIN FE 1-20 TABLET

Prescription Drug - Generic

$0

—

16714040703

LARIN 1.5 MG-30 MCG TABLET

Prescription Drug - Generic

$0

—

16714040803

LARIN 21 1-20 TABLET

Prescription Drug - Generic

$0

—

16714041603

LARIN 24 FE 1 MG-20 MCG TABLET

Prescription Drug - Generic

$0

—

16714044004

DEBLITANE 0.35 MG TABLET

Prescription Drug - Generic

$0

—

16714044104

SHAROBEL 0.35 MG TABLET

Prescription Drug - Generic

$0

—

16714046404

JULEBER 28 DAY TABLET

Prescription Drug - Generic

$0

—

16714080901

NEW DAY 1.5 MG TABLET

Prescription Drug - Generic

$6

—

16729003116

METHYLDOPA 500 MG TABLET

Prescription Drug - Generic

$0

—

16729050243

FUROSEMIDE 100 MG/10 ML VIAL

Prescription Drug - Generic

$0

—

16729053308

DODEX 1,000 MCG/ML VIAL

Prescription Drug - Generic

$2

—

16781046275

CLINDAGEL 1% GEL

Prescription Drug - Brand

$22

—

169413602

OZEMPIC 1 MG/DOSE (2 MG/1.5 ML) PEN

Prescription Drug - Brand

$285

—

17000

Destruct premalg lesion

Surgery - Integumentary

$48

—

17003

Destruct premalg les 2-14

Surgery - Integumentary

$2

—

17004

Destroy premal lesions 15/>

Surgery - Integumentary

$83

—

17106

Dstr cut vsc prlf les<10sqcm

Surgery - Integumentary

$239

—

17107

Dstr cut vsc prlf les10-50sq

Surgery - Integumentary

$309

—

17108

Dstr cut vsc prlf les>50sqcm

Surgery - Integumentary

$454

—

17110

Destruction b9 les up to 14

Surgery - Integumentary

$62

—

17111

Destruction b9 lesions 15/>

Surgery - Integumentary

$74

—

17250

Chem caut of granltj tissue

Surgery - Integumentary

$35

—

17260

Dstrj mal les t/a/l 0.5 cm/<

Surgery - Integumentary

$59

—

17261

Dstrj mal les t/a/l .6-1.0cm

Surgery - Integumentary

$74

—

17262

Dstrj mal les t/a/l 1.1-2.0

Surgery - Integumentary

$93

—

17263

Dstrj mal les t/a/l 2.1-3.0

Surgery - Integumentary

$103

—

17264

Dstrj mal les t/a/l 3.1-4.0

Surgery - Integumentary

$109

—

17266

Dstrj mal les t/a/l >4.0 cm

Surgery - Integumentary

$128

—

17270

Dstr mal les s/n/h/f/g .5 /<

Surgery - Integumentary

$81

—

My Cost List