Medical Procedure Costs

66993036230

DAPAGLIFLOZIN-METFORMIN ER 10-1,000 MG TABLET

Prescription Drug - Generic

$12

—

66993037202

PHENYTOIN 50 MG INFATAB CHEW

Prescription Drug - Generic

$0

—

66993042930

TAFLUPROST 0.0015% EYE DROP

Prescription Drug - Generic

$3

—

66993045630

DAPAGLIFLOZIN 5 MG TABLET

Prescription Drug - Generic

$11

—

66993045730

DAPAGLIFLOZIN 10 MG TABLET

Prescription Drug - Generic

$11

—

66993047096

CROMOLYN SODIUM 100 MG/5 ML

Prescription Drug - Generic

$1

—

66993047202

NISOLDIPINE ER 8.5 MG TABLET

Prescription Drug - Generic

$4

—

66993047302

NISOLDIPINE ER 17 MG TABLET

Prescription Drug - Generic

$5

—

66993047502

NISOLDIPINE ER 34 MG TABLET

Prescription Drug - Generic

$6

—

66993049528

TERIPARATIDE 600 MCG/2.4 ML PEN

Prescription Drug - Generic

$790

—

66993058497

FLUTICASONE-SALMETEROL 100-50

Prescription Drug - Generic

$1

—

66993058597

FLUTICASONE-SALMETEROL 250-50

Prescription Drug - Generic

$1

—

66993058697

FLUTICASONE-SALMETEROL 500-50

Prescription Drug - Generic

$2

—

66993060581

ETONOGESTREL-EE VAGINAL RING

Prescription Drug - Generic

$50

—

66993078030

PHENTERMINE-TOPIRAMATE ER 3.75-23 MG CAPSULE

Prescription Drug - Generic

$3

—

66993078130

PHENTERMINE-TOPIRAMATE ER 7.5-46 MG CAPSULE

Prescription Drug - Generic

$3

—

66993078230

PHENTERMINE-TOPIRAMATE ER 11.25-69 MG CAPSULE

Prescription Drug - Generic

$3

—

66993078330

PHENTERMINE-TOPIRAMATE ER 15-92 MG CAPSULE

Prescription Drug - Generic

$4

—

66993079097

FLUTICASONE PROP 50 MCG DISKUS

Prescription Drug - Generic

$2

—

66993079197

FLUTICASONE PROP 100 MCG DISKUS

Prescription Drug - Generic

$2

—

66993079297

FLUTICASONE PROP 250 MCG DISK

Prescription Drug - Generic

$3

—

66993082130

PIOGLITAZONE-GLIMEPIRIDE 30-2

Prescription Drug - Generic

$11

—

66993082230

PIOGLITAZONE-GLIMEPIRIDE 30-4

Prescription Drug - Generic

$11

—

66993084451

PREDNISOLONE ODT 10 MG TABLET

Prescription Drug - Generic

$7

—

66993087555

SODIUM SULFACETAMIDE 10% LOT

Prescription Drug - Generic

$1

—

66993088061

PREDNICARBATE 0.1% CREAM

Prescription Drug - Generic

$1

—

66993088771

ALICLEN 6% SHAMPOO

Prescription Drug - Generic

$0

—

66993093861

CALCIPOTRIENE-BETAMETH DP OINT

Prescription Drug - Generic

$3

—

66993093865

CALCIPOTRIENE-BETAMETHASONE DP 0.005%-0.064% OINTMENT

Prescription Drug - Generic

$2

—

66993095344

TESTOSTERONE 12.5 MG/1.25 GRAM

Prescription Drug - Generic

$1

—

66993095430

TESTOSTERONE 1% (25 MG/2.5 G) PK

Prescription Drug - Generic

$2

—

66993098928

TERIPARATIDE 560 MCG/2.24 ML PEN

Prescription Drug - Generic

$596

—

67005

Partial removal of eye fluid

Surgery - Eye

$414

—

67010

Partial removal of eye fluid

Surgery - Eye

$468

—

67015

Release of eye fluid

Surgery - Eye

$524

—

67025

Replace eye fluid

Surgery - Eye

$540

—

67027

Implant eye drug system

Surgery - Eye

$715

—

67028

Injection eye drug

Surgery - Eye

$75

—

67030

Incise inner eye strands

Surgery - Eye

$491

—

67031

Laser surgery eye strands

Surgery - Eye

$306

—

67036

Removal of inner eye fluid

Surgery - Eye

$759

—

67039

Laser treatment of retina

Surgery - Eye

$809

—

67040

Laser treatment of retina

Surgery - Eye

$870

—

67041

Vit for macular pucker

Surgery - Eye

$955

—

67042

Vit for macular hole

Surgery - Eye

$955

—

67043

Vit for membrane dissect

Surgery - Eye

$1,005

—

67101

Repair detached retina crtx

Surgery - Eye

$246

—

67105

Repair detached retina pc

Surgery - Eye

$237

—

67107

Repair detached retina

Surgery - Eye

$940

—

67108

Repair detached retina

Surgery - Eye

$992

—

My Cost List