Medical Procedure Costs

64950034247

HYCODAN 5 MG-1.5 MG/5 ML SOLN

Prescription Drug - Brand

$0

—

64950034416

METOCLOPRAMIDE 5 MG/5 ML SOLN

Prescription Drug - Generic

$0

—

64950037147

HYDROCODONE-HOMATROPINE SOLN

Prescription Drug - Generic

$0

—

64950037416

ACETAMINOPHEN-CODEINE 120 MG-12 MG/5 ML SOLUTION

Prescription Drug - Generic

$0

—

64980010401

PHOSPHA 250 NEUTRAL TABLET

Prescription Drug - Generic

$0

—

64980012460

DIFLORASONE 0.05% OINTMENT

Prescription Drug - Generic

$2

—

64980014901

PROBENECID-COLCHICINE TABS

Prescription Drug - Generic

$1

—

64980017501

CARISOPRODL-ASPIRIN 200-325 MG

Prescription Drug - Generic

$1

—

64980017750

CHLOROQUINE PH 250 MG TABLET

Prescription Drug - Generic

$2

—

64980017802

CHLOROQUINE PH 500 MG TABLET

Prescription Drug - Generic

$6

—

64980022003

PYRIDOSTIGMINE ER 180 MG TAB

Prescription Drug - Generic

$4

—

64980022101

METHYLPHENIDATE 2.5 MG CHEW TB

Prescription Drug - Generic

$1

—

64980022201

METHYLPHENIDATE 5 MG CHEW TAB

Prescription Drug - Generic

$2

—

64980022301

METHYLPHENIDATE 10 MG CHEW TAB

Prescription Drug - Generic

$3

—

64980029410

SODIUM BICARB 10 GRAIN TABLET

Prescription Drug - Generic

$0

—

64980030230

PROCTO-PAK 1% CREAM

Prescription Drug - Generic

$1

—

64980030550

DENTA 5000 PLUS CREAM

Prescription Drug - Generic

$0

—

64980030760

DENTAGEL 1.1% GEL

Prescription Drug - Generic

$0

—

64980032430

PROCTOZONE-HC 2.5% CREAM

Prescription Drug - Generic

$0

—

64980032802

ERYTHROMYCIN-BENZOYL GEL

Prescription Drug - Generic

$1

—

64980034003

ALENDRONATE SODIUM 10 MG TAB

Prescription Drug - Generic

$0

—

64980040350

CEFPODOXIME 100 MG/5 ML SUSP

Prescription Drug - Generic

$1

—

64980042602

TINIDAZOLE 250 MG TABLET

Prescription Drug - Generic

$1

—

64980042712

TINIDAZOLE 500 MG TABLET

Prescription Drug - Generic

$2

—

64980044715

CALCITRIOL 1 MCG/ML SOLUTION

Prescription Drug - Generic

$5

—

64980044801

NEOMYCIN-POLYMYXIN-HC EAR SUSP

Prescription Drug - Generic

$4

—

64980050312

LEVOCARNITINE 100 MG/ML SOLN

Prescription Drug - Generic

$1

—

64980050448

CYPROHEPTADINE 2 MG/5 ML SYRUP

Prescription Drug - Generic

$0

—

64980051110

CLINDAMYCIN PEDIATRIC 75 MG/5 ML

Prescription Drug - Generic

$0

—

64980051301

TIMOLOL 0.25% EYE DROPS

Prescription Drug - Generic

$0

—

64980053101

OXYBUTYNIN 2.5 MG TABLET

Prescription Drug - Generic

$2

—

64980057301

PHENYTOIN 50 MG TABLET CHEW

Prescription Drug - Generic

$0

—

64980066601

MEXILETINE 150 MG CAPSULE

Prescription Drug - Generic

$0

—

64980066701

MEXILETINE 200 MG CAPSULE

Prescription Drug - Generic

$0

—

64980066801

MEXILETINE 250 MG CAPSULE

Prescription Drug - Generic

$0

—

64980070501

FEXMID 7.5 MG TABLET

Prescription Drug - Generic

$0

—

65038005503

ADLARITY 5 MG/DAY WEEKLY PATCH

Prescription Drug - Brand

$108

—

65038005603

ADLARITY 10 MG/DAY WEEKLY PATCH

Prescription Drug - Brand

$108

—

65038028699

AZSTARYS 26.1 MG-5.2 MG CAP

Prescription Drug - Brand

$14

—

65038042999

AZSTARYS 39.2 MG-7.8 MG CAP

Prescription Drug - Brand

$14

—

65038056199

AZSTARYS 52.3 MG-10.4 MG CAP

Prescription Drug - Brand

$14

—

65091

Revise eye

Surgery - Eye

$663

—

65093

Revise eye with implant

Surgery - Eye

$660

—

65101

Removal of eye

Surgery - Eye

$760

—

65103

Remove eye/insert implant

Surgery - Eye

$781

—

65105

Remove eye/attach implant

Surgery - Eye

$848

—

65110

Removal of eye

Surgery - Eye

$1,146

—

65112

Remove eye/revise socket

Surgery - Eye

$1,307

—

65114

Remove eye/revise socket

Surgery - Eye

$1,359

—

65125

Revise ocular implant

Surgery - Eye

$261

—

My Cost List