Medical Procedure Costs

68180090473

TYDEMY 3-0.03-0.451 MG TABLET

Prescription Drug - Generic

$3

—

68180091173

MIBELAS 24 FE CHEWABLE TABLET

Prescription Drug - Generic

$0

—

68180094702

BETAMETHASONE DP AUG 0.05% OIN

Prescription Drug - Generic

$0

—

68180094902

DESOXIMETASONE 0.05% CREAM

Prescription Drug - Generic

$1

—

68180095403

HYDROCORTISONE VAL 0.2% CREAM

Prescription Drug - Generic

$0

—

68180096412

TIOTROPIUM 18 MCG CAP-INHALER

Prescription Drug - Generic

$12

—

68200

Treat eyelid by injection

Surgery - Eye

$29

—

68220008330

PREFERA-OB PLUS DHA COMBO PACK

Prescription Drug - Brand

$1

—

68220008630

PREFERA-OB ONE SOFTGEL

Prescription Drug - Brand

$3

—

68220011310

LEVSIN-SL 0.125 MG TABLET SL

Prescription Drug - Brand

$3

—

68220011810

NULEV 0.125 MG CHEWABLE MELT

Prescription Drug - Generic

$0

—

68220013301

COLYTE WITH FLAVOR PACKS

Prescription Drug - Brand

$0

—

68220014210

PROCTOFOAM-HC FOAM

Prescription Drug - Brand

$12

—

68308011501

METHAMPHETAMINE 5 MG TABLET

Prescription Drug - Generic

$6

—

68308012750

CLINDAMYC-BNZ PEROX 1.2-3.75%

Prescription Drug - Generic

$3

—

68308022401

LORCET 5-325 MG TABLET

Prescription Drug - Brand

$2

—

68308022501

LORCET PLUS 7.5-325 MG TABLET

Prescription Drug - Brand

$2

—

68308026930

FOLCAPS OMEGA-3 CAPSULE

Prescription Drug - Generic

$1

—

68308032410

FOLCAPS TABLET

Prescription Drug - Generic

$0

—

68308032560

FOLTABS 800 TABLET

Prescription Drug - Generic

$0

—

68308035230

FOLCAL DHA CAPSULE

Prescription Drug - Generic

$1

—

68308047547

OXYCODONE-ACETAMINOPHEN 7.5-325 MG TAB

Prescription Drug - Generic

$0

—

68308050260

MI-OMEGA NF CAPSULE

Prescription Drug - Generic

$1

—

68308055410

ZEBUTAL 50-325-40 MG CAPSULE

Prescription Drug - Generic

$3

—

68308066355

METRONIDAZOLE TOP 1% GEL PUMP

Prescription Drug - Generic

$0

—

68308066360

METRONIDAZOLE TOPICAL 1% GEL

Prescription Drug - Generic

$1

—

68308066510

CALCITRIOL 3 MCG/G OINTMENT

Prescription Drug - Generic

$5

—

68308066625

ADAPALENE 0.3% GEL

Prescription Drug - Generic

$0

—

68308066645

ADAPALENE 0.3% GEL PUMP

Prescription Drug - Generic

$1

—

68308071259

METRONIDAZOLE 0.75% LOTION

Prescription Drug - Generic

$2

—

68308071630

DOXYCYCLINE HYC DR 200 MG TAB

Prescription Drug - Generic

$4

—

68308074530

TAZAROTENE 0.1% CREAM

Prescription Drug - Generic

$2

—

68308074708

IMVEXXY 4 MCG MAINTENANCE PACK

Prescription Drug - Brand

$26

—

68308074718

IMVEXXY 4 MCG STARTER PACK

Prescription Drug - Brand

$26

—

68308074808

IMVEXXY 10 MCG MAINTENANCE PAK

Prescription Drug - Brand

$26

—

68308074818

IMVEXXY 10 MCG STARTER PACK

Prescription Drug - Brand

$26

—

68308075030

BIJUVA 1 MG-100 MG CAPSULE

Prescription Drug - Brand

$8

—

68308075130

BIJUVA 0.5 MG-100 MG CAPSULE

Prescription Drug - Brand

$8

—

68308075201

ANNOVERA VAGINAL RING

Prescription Drug - Brand

$2,317

—

68308077560

DOXYCYCLINE HYC DR 75 MG TAB

Prescription Drug - Generic

$7

—

68308077750

TRETINOIN GEL MICRO 0.08% PUMP

Prescription Drug - Generic

$7

—

68308084501

OXYCODONE-ASPIRIN 4.8355-325 MG TABLET

Prescription Drug - Generic

$1

—

68320

Revise/graft eyelid lining

Surgery - Eye

$468

—

68325

Revise/graft eyelid lining

Surgery - Eye

$560

—

68326

Revise/graft eyelid lining

Surgery - Eye

$552

—

68328

Revise/graft eyelid lining

Surgery - Eye

$599

—

68330

Revise eyelid lining

Surgery - Eye

$397

—

68335

Revise/graft eyelid lining

Surgery - Eye

$553

—

68340

Separate eyelid adhesions

Surgery - Eye

$356

—

68360

Revise eyelid lining

Surgery - Eye

$355

—

My Cost List