Medical Procedure Costs

68362

Revise eyelid lining

Surgery - Eye

$559

—

68371

Harvest eye tissue alograft

Surgery - Eye

$359

—

68382001801

VENLAFAXINE HCL 25 MG TABLET

Prescription Drug - Generic

$0

—

68382001901

VENLAFAXINE HCL 37.5 MG TABLET

Prescription Drug - Generic

$0

—

68382002001

VENLAFAXINE HCL 50 MG TABLET

Prescription Drug - Generic

$0

—

68382002101

VENLAFAXINE HCL 75 MG TABLET

Prescription Drug - Generic

$0

—

68382004001

PROMETHAZINE 12.5 MG TABLET

Prescription Drug - Generic

$0

—

68382004110

PROMETHAZINE 25 MG TABLET

Prescription Drug - Generic

$0

—

68382004201

PROMETHAZINE 50 MG TABLET

Prescription Drug - Generic

$0

—

68382010101

VENLAFAXINE HCL 100 MG TABLET

Prescription Drug - Generic

$0

—

68382010601

DIVALPROEX SODIUM 125 MG CAP

Prescription Drug - Generic

$1

—

68382010610

DIVALPROEX DR 125 MG CP(SPRNK)

Prescription Drug - Generic

$0

—

68382011006

BROMOCRIPTINE 5 MG CAPSULE

Prescription Drug - Generic

$4

—

68382011901

AZATHIOPRINE 75 MG TABLET

Prescription Drug - Generic

$9

—

68382012001

AZATHIOPRINE 100 MG TABLET

Prescription Drug - Generic

$4

—

68382018401

GLIPIZIDE-METFORMIN 2.5-250 MG

Prescription Drug - Generic

$0

—

68382018501

GLIPIZIDE-METFORMIN 2.5-500 MG

Prescription Drug - Generic

$0

—

68382018601

GLIPIZIDE-METFORMIN 5-500 MG

Prescription Drug - Generic

$0

—

68382020906

ANASTROZOLE 1 MG TABLET

Prescription Drug - Generic

$0

—

68382027114

ETODOLAC ER 400 MG TABLET

Prescription Drug - Generic

$1

—

68382027201

ETODOLAC ER 500 MG TABLET

Prescription Drug - Generic

$1

—

68382027314

ETODOLAC ER 600 MG TABLET

Prescription Drug - Generic

$1

—

68382031601

MINOCYCLINE 50 MG CAPSULE

Prescription Drug - Generic

$0

—

68382031701

MINOCYCLINE 75 MG CAPSULE

Prescription Drug - Generic

$0

—

68382031818

MINOCYCLINE 100 MG CAPSULE

Prescription Drug - Generic

$0

—

68382033401

TRAMADOL-ACETAMINOPHN 37.5-325

Prescription Drug - Generic

$0

—

68382035806

TOPIRAMATE ER 200 MG CAPSULE

Prescription Drug - Generic

$22

—

68382043528

MESALAMINE 800 MG DR TABLET

Prescription Drug - Generic

$4

—

68382045219

MESALAMINE ER 0.375 GRAM CAP

Prescription Drug - Generic

$0

—

68382048116

PITAVASTATIN 1 MG TABLET

Prescription Drug - Generic

$1

—

68382052842

CHOLESTYRAMINE POWDER

Prescription Drug - Generic

$0

—

68382052860

CHOLESTYRAMINE PACKET

Prescription Drug - Generic

$1

—

68382052942

CHOLESTYRAMINE LIGHT POWDER

Prescription Drug - Generic

$0

—

68382052960

CHOLESTYRAMINE LIGHT PACKET

Prescription Drug - Generic

$1

—

68382059101

PERPHENAZINE 2 MG TABLET

Prescription Drug - Generic

$0

—

68382059201

PERPHENAZINE 4 MG TABLET

Prescription Drug - Generic

$0

—

68382059301

PERPHENAZINE 8 MG TABLET

Prescription Drug - Generic

$0

—

68382059401

PERPHENAZINE 16 MG TABLET

Prescription Drug - Generic

$0

—

68382059516

DILTIAZEM 24H ER(CD) 120 MG CP

Prescription Drug - Generic

$0

—

68382059616

DILTIAZEM 24H ER(CD) 180 MG CP

Prescription Drug - Generic

$0

—

68382059716

DILTIAZEM 24H ER(CD) 240 MG CP

Prescription Drug - Generic

$0

—

68382059816

DILTIAZEM 24H ER(CD) 300 MG CP

Prescription Drug - Generic

$0

—

68382059916

DILTIAZEM 24H ER(CD) 360 MG CP

Prescription Drug - Generic

$0

—

68382060716

GABAPENTIN ER 600 MG TABLET

Prescription Drug - Generic

$1

—

68382060816

GABAPENTIN ER 300 MG TABLET

Prescription Drug - Generic

$1

—

68382064016

DUTASTERIDE-TAMSULOSIN 0.5-0.4

Prescription Drug - Generic

$2

—

68382065001

ISOSORBIDE MN ER 30 MG TABLET

Prescription Drug - Generic

$0

—

68382065201

ISOSORBIDE MN ER 120 MG TAB

Prescription Drug - Generic

$0

—

68382065906

PYRIDOSTIGMINE BR 60 MG TABLET

Prescription Drug - Generic

$0

—

68382070718

DOXYCYCLINE MONO 100 MG CAP

Prescription Drug - Generic

$0

—

My Cost List