Medical Procedure Costs

00037024330

ASTEPRO 0.15% NASAL SPRAY

Prescription Drug - Brand

$5

—

00037024523

DYMISTA NASAL SPRAY

Prescription Drug - Brand

$9

—

00037043001

FELBATOL 400 MG TABLET

Prescription Drug - Brand

$15

—

00037043101

FELBATOL 600 MG TABLET

Prescription Drug - Brand

$17

—

00037044267

FELBATOL 600 MG/5 ML SUSP

Prescription Drug - Brand

$6

—

00037067896

GASTROCROM 100 MG/5 ML CONC

Prescription Drug - Brand

$2

—

00037200101

SOMA 350 MG TABLET

Prescription Drug - Brand

$11

—

00037225030

SOMA 250 MG TABLET

Prescription Drug - Brand

$5

—

00037480170

ELESTRIN 0.06% GEL

Prescription Drug - Brand

$4

—

00037601093

EDLUAR 10 MG SL TABLET

Prescription Drug - Brand

$16

—

00037632190

URELLE TABLET

Prescription Drug - Brand

$9

—

00037682210

PROCTOFOAM-HC 1%-1% FOAM

Prescription Drug - Brand

$19

—

00037682315

PROCTOFOAM 1% FOAM

Prescription Drug - Brand

$7

—

00037682410

EPIFOAM FOAM

Prescription Drug - Brand

$10

—

00037683015

CORTIFOAM 10% AEROSOL

Prescription Drug - Brand

$31

—

00037686010

DIPENTUM 250 MG CAPSULE

Prescription Drug - Brand

$16

—

00037702560

OPTIVAR 0.05% DROPS

Prescription Drug - Brand

$22

—

00037759012

AEROSPAN 80 MCG INHALER

Prescription Drug - Brand

$21

—

00037813006

MUSE 500 MCG URETHRAL SUPPOS

Prescription Drug - Brand

$53

—

00037814001

MUSE 1,000 MCG URETHRAL SUPP

Prescription Drug - Brand

$72

—

00039006605

LASIX 80 MG TABLET

Prescription Drug - Brand

$1

—

00039022210

AMARYL 2 MG TABLET

Prescription Drug - Brand

$2

—

00039022310

AMARYL 4 MG TABLET

Prescription Drug - Brand

$4

—

0003M

Molecular pathology test for liver disease, including non-alcohol liver disease

Pathology/Laboratory

$503

—

0003U

Measurement of proteins associated with ovarian cancer in serum

Pathology/Laboratory

$950

—

00046087221

PREMARIN VAGINAL CREAM-APPL

Prescription Drug - Brand

$15

—

00046106505

PHOSPHOLINE IODIDE 0.125%

Prescription Drug - Brand

$17

—

00046110091

PREMARIN 0.3 MG TABLET

Prescription Drug - Brand

$7

—

00046110181

PREMARIN 0.45 MG TABLET

Prescription Drug - Brand

$7

—

00046110291

PREMARIN 0.625 MG TABLET

Prescription Drug - Brand

$7

—

00046110381

PREMARIN 0.9 MG TABLET

Prescription Drug - Brand

$7

—

00046110491

PREMARIN 1.25 MG TABLET

Prescription Drug - Brand

$7

—

00046110511

PREMPRO 0.3 MG-1.5 MG TABLET

Prescription Drug - Brand

$9

—

00046110611

PREMPRO 0.45-1.5 MG TABLET

Prescription Drug - Brand

$9

—

00046110711

PREMPRO 0.625-2.5 MG TABLET

Prescription Drug - Brand

$9

—

00046110811

PREMPRO 0.625-5 MG TABLET

Prescription Drug - Brand

$9

—

00046257512

PREMPHASE 0.625-5 MG TABLET

Prescription Drug - Brand

$9

—

00049017403

GLUCOTROL XL 5 MG TABLET

Prescription Drug - Brand

$0

—

00049017807

GLUCOTROL XL 10 MG TABLET

Prescription Drug - Brand

$3

—

00049035260

GEODON 20 MG CAPSULE

Prescription Drug - Brand

$26

—

00049035860

GEODON 80 MG CAPSULE

Prescription Drug - Brand

$31

—

00049276066

CARDURA 2 MG TABLET

Prescription Drug - Brand

$4

—

00049277066

CARDURA 4 MG TABLET

Prescription Drug - Brand

$5

—

00049350079

DIFLUCAN 150 MG TABLET

Prescription Drug - Brand

$58

—

00049397060

GEODON 40 MG CAPSULE

Prescription Drug - Brand

$19

—

00049398060

GEODON 60 MG CAPSULE

Prescription Drug - Brand

$23

—

0004M

Molecular pathology test for genetic analysis of curved spine deformity

Pathology/Laboratory

$79

—

00051842530

ANDROGEL 1%(2.5G) GEL PACKET

Prescription Drug - Brand

$8

—

00051845030

ANDROGEL 1%(5G) GEL PACKET

Prescription Drug - Brand

$4

—

00051846230

ANDROGEL 1.62%(2.5G) GEL PCKT

Prescription Drug - Brand

$8

—

My Cost List