Medical Procedure Costs

00024592605

ADMELOG 100 UNIT/ML VIAL

Prescription Drug - Brand

$13

—

00025006131

LOMOTIL 2.5-0.025 MG TABLET

Prescription Drug - Brand

$3

—

00025100131

ALDACTONE 25 MG TABLET

Prescription Drug - Brand

$2

—

00025101131

ALDACTAZIDE 25-25 TABLET

Prescription Drug - Brand

$3

—

00025102131

ALDACTAZIDE 50-50 TABLET

Prescription Drug - Brand

$5

—

00025138131

DAYPRO 600 MG CAPLET

Prescription Drug - Brand

$8

—

00025141190

ARTHROTEC 50 MG-200 MCG TAB

Prescription Drug - Brand

$8

—

00025142160

ARTHROTEC 75 MG-200 MCG TAB

Prescription Drug - Brand

$9

—

00025151501

CELEBREX 50 MG CAPSULE

Prescription Drug - Brand

$4

—

00025153002

CELEBREX 400 MG CAPSULE

Prescription Drug - Brand

$20

—

00025172003

INSPRA 50 MG TABLET

Prescription Drug - Brand

$11

—

00025189151

CALAN SR 240 MG CAPLET

Prescription Drug - Brand

$9

—

00025196130

FLAGYL ER 750 MG TABLET

Prescription Drug - Brand

$22

—

00025273231

NORPACE CR 100 MG CAPSULE

Prescription Drug - Brand

$4

—

00025274231

NORPACE CR 150 MG CAPSULE

Prescription Drug - Brand

$5

—

00029152544

BACTROBAN 2% OINTMENT

Prescription Drug - Brand

$6

—

00029152611

BACTROBAN NASAL 2% OINTMENT

Prescription Drug - Brand

$16

—

00029152725

BACTROBAN 2% CREAM

Prescription Drug - Brand

$6

—

0002M

Molecular pathology test for liver disease, including alcohol liver disease

Pathology/Laboratory

$503

—

0002U

Measurement of substances in urine to predict likelihood of polyps in large

Pathology/Laboratory

$25

—

00031223419

DIMETAPP COLD & COUGH LIQUID

Prescription Drug - Brand

$0

—

00031223519

DIMETAPP COLD & ALLERGY ELIXIR

Prescription Drug - Brand

$0

—

00031223813

DIMETAPP LONG-ACTING COUGH LIQ

Prescription Drug - Brand

$0

—

00031224612

CHILD'S DIMETAPP COLD-FLU LIQ

Prescription Drug - Generic

$0

—

00031224713

DIMETAPP COLD & CONGEST LIQUID

Prescription Drug - Brand

$0

—

00031861318

ROBITUSSIN COUGH-COLD CF MAX

Prescription Drug - Brand

$0

—

00031866819

ROBITUSSIN DM MAX LIQUID

Prescription Drug - Brand

$0

—

00031869312

ROBITUSSIN LONG-ACTING LIQ

Prescription Drug - Brand

$0

—

00031869412

ROBITUSSIN PEDIATRIC COUGH SYP

Prescription Drug - Brand

$0

—

00031871612

ROBITUSSIN COUGH-COLD CF LIQ

Prescription Drug - Brand

$0

—

00031871712

ROBITUSSIN NIGHTTIME COUGH DM

Prescription Drug - Brand

$0

—

00031872120

ROBITUSSIN COLD-FLU DAY CAPSUL

Prescription Drug - Brand

$0

—

00031872220

ROBITUSSIN COLD-FLU NIGHT CAPSULE

Prescription Drug - Brand

$0

—

00031872412

ROBITUSSIN MUCUS-CHEST CONGEST

Prescription Drug - Brand

$0

—

00031873220

ADT ROBITUSSIN NGT NASL RLF TB

Prescription Drug - Brand

$0

—

00031873418

ADULT ROBITUSSIN M-S COLD LIQ

Prescription Drug - Brand

$0

—

00031873518

ADT ROBITUSSIN NGT M-S COLD LQ

Prescription Drug - Brand

$0

—

00031873712

ADULT ROBITUSSIN PEAK COLD LIQ

Prescription Drug - Brand

$0

—

00031873818

ADT ROBITUSSIN PEAK CLD DM MAX

Prescription Drug - Brand

$0

—

00031874012

ADT ROBITUSSIN LINGER COLD SYR

Prescription Drug - Brand

$0

—

00031874214

ADT ROBITUSSIN PEAK CLD M-S LQ

Prescription Drug - Brand

$0

—

00032120370

CREON DR 3,000 UNIT CAPSULE

Prescription Drug - Brand

$2

—

00032120601

CREON DR 6,000 UNIT CAPSULE

Prescription Drug - Brand

$2

—

00032120607

CREON DR 6,000 UNITS CAPSULE

Prescription Drug - Brand

$2

—

00032121201

CREON DR 12,000 UNIT CAPSULE

Prescription Drug - Brand

$4

—

00032121207

CREON DR 12,000 UNITS CAPSULE

Prescription Drug - Brand

$3

—

00032122407

CREON DR 24,000 UNITS CAPSULE

Prescription Drug - Brand

$7

—

00032263601

CREON DR 24,000 UNIT CAPSULE

Prescription Drug - Brand

$8

—

00032301613

CREON DR 36,000 UNIT CAPSULE

Prescription Drug - Brand

$13

—

00032301628

CREON DR 36,000 UNITS CAPSULE

Prescription Drug - Brand

$10

—

My Cost List