Medical Procedure Costs

68462088194

TACROLIMUS 0.03% OINTMENT

Prescription Drug - Generic

$1

—

68462089610

OCTREOTIDE ACET 100 MCG/ML VL

Prescription Drug - Generic

$3

—

68500

Removal of tear gland

Surgery - Eye

$921

—

68505

Partial removal tear gland

Surgery - Eye

$918

—

68510

Biopsy of tear gland

Surgery - Eye

$235

—

68520

Removal of tear sac

Surgery - Eye

$644

—

68525

Biopsy of tear sac

Surgery - Eye

$206

—

68530

Clearance of tear duct

Surgery - Eye

$213

—

68540

Remove tear gland lesion

Surgery - Eye

$847

—

68546014256

AZILECT 0.5 MG TABLET

Prescription Drug - Brand

$44

—

68546017060

AUSTEDO 6 MG TABLET

Prescription Drug - Brand

$84

—

68546017160

AUSTEDO 9 MG TABLET

Prescription Drug - Brand

$94

—

68546017260

AUSTEDO 12 MG TABLET

Prescription Drug - Brand

$125

—

68546022956

AZILECT 1 MG TABLET

Prescription Drug - Brand

$44

—

68546031730

COPAXONE 20 MG/ML SYRINGE

Prescription Drug - Brand

$230

—

68546032512

COPAXONE 40 MG/ML SYRINGE

Prescription Drug - Brand

$542

—

68546047056

AUSTEDO XR 6 MG TABLET

Prescription Drug - Brand

$84

—

68546047156

AUSTEDO XR 12 MG TABLET

Prescription Drug - Brand

$167

—

68546047256

AUSTEDO XR 24 MG TABLET

Prescription Drug - Brand

$251

—

68546047356

AUSTEDO XR 30 MG TABLET

Prescription Drug - Brand

$335

—

68546047456

AUSTEDO XR 36 MG TABLET

Prescription Drug - Brand

$416

—

68546047556

AUSTEDO XR 42 MG TABLET

Prescription Drug - Brand

$500

—

68546047656

AUSTEDO XR 48 MG TABLET

Prescription Drug - Brand

$499

—

68546047729

AUSTEDO XR TITR(12-18-24-30 MG)

Prescription Drug - Brand

$249

—

68546047956

AUSTEDO XR 18 MG TABLET

Prescription Drug - Brand

$252

—

68550

Remove tear gland lesion

Surgery - Eye

$1,053

—

68599230206

ISOPROPYL RUBBING ALCOHOL 70%

Prescription Drug - Generic

$0

—

68599350205

PVP PREP 10% SOLUTION

Prescription Drug - Generic

$0

—

68599474407

BISMUTH 262 MG TABLET CHEW

Prescription Drug - Generic

$0

—

68599540103

ANTISEPTIC SKIN CLEANSER 4%

Prescription Drug - Generic

$0

—

68645056690

LOVASTATIN 20 MG TABLET

Prescription Drug - Generic

$0

—

68645056790

LOVASTATIN 40 MG TABLET

Prescription Drug - Generic

$0

—

68645060354

NIFEDIPINE ER 30 MG TABLET

Prescription Drug - Generic

$0

—

68645060454

NIFEDIPINE ER 60 MG TABLET

Prescription Drug - Generic

$0

—

68682001004

SODIUM SULFACETAMIDE 10% LOTN

Prescription Drug - Generic

$1

—

68682019050

CLINDA-BENZOYL PEROX 1-5% PUMP

Prescription Drug - Generic

$2

—

68682037290

DILTIAZEM 24HR ER 420 MG CAP

Prescription Drug - Generic

$1

—

68682051384

TRETINOIN GEL MICRO 0.1% TUBE

Prescription Drug - Generic

$7

—

68682051385

TRETINOIN GEL MICRO 0.1% PUMP

Prescription Drug - Generic

$8

—

68682051494

TRETINOIN GEL MICRO 0.04% TUBE

Prescription Drug - Generic

$7

—

68682051495

TRETINOIN GEL MICRO 0.04% PUMP

Prescription Drug - Generic

$9

—

68682052101

DILTIAZEM 24HR CD 360 MG CAP

Prescription Drug - Generic

$3

—

68682065020

DIAZEPAM 2.5 MG RECTAL GEL(2PK)

Prescription Drug - Generic

$208

—

68682065220

DIAZEPAM 10 MG RECTAL GEL SYST

Prescription Drug - Generic

$231

—

68682065520

DIAZEPAM 20 MG RECTAL GEL SYST

Prescription Drug - Generic

$244

—

68682070590

DILTIAZEM 24HR ER 180 MG TAB

Prescription Drug - Generic

$2

—

68682070630

DILTIAZEM 24HR ER 240 MG TAB

Prescription Drug - Generic

$2

—

68682070690

DILTIAZEM ER 240 MG TABLET

Prescription Drug - Generic

$3

—

68682070730

DILTIAZEM 24HR ER 300 MG TAB

Prescription Drug - Generic

$3

—

68682070830

DILTIAZEM 24HR ER 360 MG TAB

Prescription Drug - Generic

$3

—

My Cost List