Medical Procedure Costs

67909

Revise eyelid defect

Surgery - Eye

$379

—

67911

Revise eyelid defect

Surgery - Eye

$477

—

67912

Correction eyelid w/implant

Surgery - Eye

$424

—

67914

Repair eyelid defect

Surgery - Eye

$292

—

67915

Repair eyelid defect

Surgery - Eye

$180

—

67916

Repair eyelid defect

Surgery - Eye

$372

—

67917

Repair eyelid defect

Surgery - Eye

$392

—

67919004199

SIVEXTRO 200 MG TABLET

Prescription Drug - Brand

$472

—

67921

Repair eyelid defect

Surgery - Eye

$277

—

67922

Repair eyelid defect

Surgery - Eye

$180

—

67923

Repair eyelid defect

Surgery - Eye

$371

—

67924

Repair eyelid defect

Surgery - Eye

$392

—

67930

Repair eyelid wound

Surgery - Eye

$197

—

67935

Repair eyelid wound

Surgery - Eye

$368

—

67938

Remove eyelid foreign body

Surgery - Eye

$100

—

67950

Revision of eyelid

Surgery - Eye

$397

—

67961

Revision of eyelid

Surgery - Eye

$390

—

67966

Revision of eyelid

Surgery - Eye

$555

—

67971

Reconstruction of eyelid

Surgery - Eye

$608

—

67973

Reconstruction of eyelid

Surgery - Eye

$777

—

67974

Reconstruction of eyelid

Surgery - Eye

$775

—

67975

Reconstruction of eyelid

Surgery - Eye

$579

—

68001022300

ISOSORBIDE DN 5 MG TABLET

Prescription Drug - Generic

$0

—

68001023206

DICLOFENAC-MISOPROST 75-0.2 TB

Prescription Drug - Generic

$2

—

68001023703

CLONIDINE HCL 0.1 MG TABLET

Prescription Drug - Generic

$0

—

68001023803

CLONIDINE HCL 0.2 MG TABLET

Prescription Drug - Generic

$0

—

68001023900

CLONIDINE HCL 0.3 MG TABLET

Prescription Drug - Generic

$0

—

68001024515

ATOVAQUONE-PROGUANIL 250-100

Prescription Drug - Generic

$5

—

68001030800

BUPROPION HCL 75 MG TABLET

Prescription Drug - Generic

$0

—

68001030900

BUPROPION HCL 100 MG TABLET

Prescription Drug - Generic

$0

—

68001044004

FEXOFENADINE HCL 180 MG TABLET

Prescription Drug - Generic

$0

—

68001044998

LORATADINE 5 MG/5 ML SOLUTION

Prescription Drug - Generic

$0

—

68001047547

ANTIFUNGAL 1% TOPICAL CREAM

Prescription Drug - Generic

$0

—

68001047747

BACITRACIN 500 UNIT/GM OINTMNT

Prescription Drug - Generic

$0

—

68001048500

METAXALONE 800 MG TABLET

Prescription Drug - Generic

$0

—

68001049500

ACETAMINOPHEN ER 650 MG TABLET

Prescription Drug - Generic

$0

—

68001052908

MECLIZINE 25 MG TABLET CHEW

Prescription Drug - Generic

$0

—

68001061200

DICLOFENAC SOD ER 100 MG TAB

Prescription Drug - Generic

$1

—

68001065217

ZENATANE 10 MG CAPSULE

Prescription Drug - Generic

$2

—

68001065317

ZENATANE 20 MG CAPSULE

Prescription Drug - Generic

$2

—

68001065417

ZENATANE 30 MG CAPSULE

Prescription Drug - Generic

$2

—

68001065517

ZENATANE 40 MG CAPSULE

Prescription Drug - Generic

$2

—

68012000316

GLUMETZA ER 1,000 MG TABLET

Prescription Drug - Brand

$107

—

68012000450

GLUMETZA ER 500 MG TABLET

Prescription Drug - Brand

$49

—

68012005230

ZEGERID 20 MG PACKET

Prescription Drug - Brand

$99

—

68012005430

ZEGERID 40 MG PACKET

Prescription Drug - Brand

$97

—

68012010430

ZEGERID 40 MG CAPSULE

Prescription Drug - Brand

$106

—

68012030930

UCERIS 9 MG ER TABLET

Prescription Drug - Brand

$57

—

68016000901

PV HYDROCORTISONE 1% OINTMENT

Prescription Drug - Generic

$0

—

68016001082

PV ACID REDUCER 10 MG TABLET

Prescription Drug - Generic

$0

—

My Cost List