Medical Procedure Costs

61269038012

PYLERA 140-125-125 MG CAPSULE

Prescription Drug - Brand

$2

—

61269038512

BISMUTH-METRONIDAZOLE-TETRACYCLINE 140-125-125 MG CAPSULE

Prescription Drug - Generic

$3

—

61269040260

DROXIA 200 MG CAPSULE

Prescription Drug - Brand

$1

—

61269040360

DROXIA 300 MG CAPSULE

Prescription Drug - Brand

$1

—

61269040460

DROXIA 400 MG CAPSULE

Prescription Drug - Brand

$1

—

61269046090

XENICAL 120 MG CAPSULE

Prescription Drug - Brand

$5

—

61269050906

PULMICORT 90 MCG FLEXHALER

Prescription Drug - Brand

$189

—

61269051812

PULMICORT 180 MCG FLEXHALER

Prescription Drug - Brand

$253

—

61269052794

CHILD ALLERGY (FEXO) 30 MG/5 ML

Prescription Drug - Generic

$0

—

61269056590

ORLISTAT 120 MG CAPSULE

Prescription Drug - Generic

$7

—

61269060510

KLONOPIN 0.5 MG TABLET

Prescription Drug - Brand

$3

—

61269061010

KLONOPIN 1 MG TABLET

Prescription Drug - Brand

$3

—

61269062010

KLONOPIN 2 MG TABLET

Prescription Drug - Brand

$4

—

61269063130

ZYPREXA 5 MG TABLET

Prescription Drug - Brand

$17

—

61269063530

ZYPREXA 20 MG TABLET

Prescription Drug - Brand

$50

—

61269073063

MICONAZOLE 7 CREAM

Prescription Drug - Generic

$0

—

61269073607

MICONAZOLE 7 100 MG VAG SUPP

Prescription Drug - Generic

$1

—

61304

Crnec/crnot expl supratntorl

Surgery - Nervous

$1,609

—

61305

Crnec/crnot expl infratntorl

Surgery - Nervous

$1,960

—

61312

Crnec/crnot sttl xdrl/sdrl

Surgery - Nervous

$2,005

—

61313

Crnec/crnot sttl icere

Surgery - Nervous

$1,948

—

61314

Crnec/crnot ittl xdrl/sdrl

Surgery - Nervous

$1,789

—

61314004475

TRIFLURIDINE 1% EYE DROPS

Prescription Drug - Generic

$22

—

61314022405

TIMOLOL 0.25% GFS GEL-SOLUTION

Prescription Drug - Generic

$26

—

61314022505

TIMOLOL 0.5% GFS GEL-SOLUTION

Prescription Drug - Generic

$13

—

61314023710

CROMOLYN 4% EYE DROPS

Prescription Drug - Generic

$1

—

61314023810

CARTEOLOL HCL 1% EYE DROPS

Prescription Drug - Generic

$2

—

61314024063

JUBBONTI 60 MG/ML SYRINGE

Prescription Drug - Brand

$1,536

—

61314024501

BETAXOLOL HCL 0.5% EYE DROP

Prescription Drug - Generic

$9

—

61314029705

SULF-PRED 10-0.25% EYE DROPS

Prescription Drug - Generic

$3

—

61314031805

ZARXIO 300 MCG/0.5 ML SYRINGE

Prescription Drug - Brand

$534

—

61314032605

ZARXIO 480 MCG/0.8 ML SYRINGE

Prescription Drug - Brand

$533

—

61314032720

ADALIMUMAB-ADAZ(CF) PEN 40 MG/0.4 ML

Prescription Drug - Generic

$1,593

—

61314039603

CYCLOPENTOLATE 1% EYE DROPS

Prescription Drug - Generic

$1

—

61314044705

METIPRANOLOL 0.3% EYE DROPS

Prescription Drug - Generic

$4

—

61314063136

NEOMYC-POLYM-DEXAMET EYE OINTM

Prescription Drug - Generic

$3

—

61314063305

GENTAMICIN 3 MG/ML EYE DROP

Prescription Drug - Generic

$1

—

61314064175

NEOMYCIN-POLY-HC EYE DROPS

Prescription Drug - Generic

$19

—

61314064725

TOBRAMYCIN-DEXAMETH OPHTH SUSP

Prescription Drug - Generic

$5

—

61314066505

APRACLONIDINE HCL 0.5% DROPS

Prescription Drug - Generic

$11

—

61315

Crnec/crnot ittl ntracereblr

Surgery - Nervous

$2,017

—

61316

Inc&subq plmt crnl bone grf

Surgery - Nervous

$80

—

61320

Crnec/crnot drg icr abs sttl

Surgery - Nervous

$1,837

—

61321

Crnec/crnot drg icr abs ittl

Surgery - Nervous

$2,069

—

61322

Crnec/crnot dcmprv w/o lobec

Surgery - Nervous

$2,304

—

61323

Crnec/crnot dcmprv w/lobec

Surgery - Nervous

$2,299

—

61330

Dcmprn orbit only transcrnl

Surgery - Nervous

$1,764

—

61333

Expl orbit w/removal lesion

Surgery - Nervous

$1,957

—

61340

Subtemporal cranial dcmprn

Surgery - Nervous

$1,428

—

61343

Crnec sopl crv lam dcmprn

Surgery - Nervous

$2,112

—

My Cost List