Medical Procedure Costs

68682070890

DILTIAZEM ER 360 MG TABLET

Prescription Drug - Generic

$4

—

68682070930

DILTIAZEM 24HR ER 420 MG TAB

Prescription Drug - Generic

$4

—

68682085060

LULICONAZOLE 1% CREAM

Prescription Drug - Generic

$3

—

68700

Repair tear ducts

Surgery - Eye

$516

—

68705

Revise tear duct opening

Surgery - Eye

$143

—

68720

Create tear sac drain

Surgery - Eye

$703

—

68727060001

LUVOX CR 100 MG CAPSULE

Prescription Drug - Brand

$12

—

68745

Create tear duct drain

Surgery - Eye

$706

—

68750

Create tear duct drain

Surgery - Eye

$749

—

68760

Close tear duct opening

Surgery - Eye

$128

—

68761

Close tear duct opening

Surgery - Eye

$104

—

68770

Close tear system fistula

Surgery - Eye

$535

—

68774040101

ALBUTEROL SULFATE ER 8 MG TAB

Prescription Drug - Generic

$3

—

68791010104

DERMA-SMOOTHE-FS BODY OIL

Prescription Drug - Brand

$0

—

68791010204

DERMA-SMOOTHE-FS SCALP OIL

Prescription Drug - Brand

$0

—

68791010320

DERMOTIC OIL 0.01% EAR DROPS

Prescription Drug - Brand

$1

—

68801

Dilate tear duct opening

Surgery - Eye

$72

—

68810

Probe nasolacrimal duct

Surgery - Eye

$112

—

68811

Probe nasolacrimal duct

Surgery - Eye

$118

—

68815

Probe nasolacrimal duct

Surgery - Eye

$193

—

68816

Probe nl duct w/balloon

Surgery - Eye

$134

—

68840

Explore/irrigate tear ducts

Surgery - Eye

$105

—

68841

Insj rx elut implt lac canal

Surgery - Eye

$27

—

68850

Injection for tear sac x-ray

Surgery - Eye

$46

—

68850001202

MYAMBUTOL 400 MG TABLET

Prescription Drug - Brand

$1

—

68968017203

SECUADO 3.8 MG/24 HR PATCH

Prescription Drug - Brand

$49

—

68968017303

SECUADO 5.7 MG/24 HR PATCH

Prescription Drug - Brand

$49

—

68968017403

SECUADO 7.6 MG/24 HR PATCH

Prescription Drug - Brand

$49

—

68968020503

XELSTRYM 4.5 MG/9 HR PATCH

Prescription Drug - Brand

$16

—

68968021003

XELSTRYM 9 MG/9 HR PATCH

Prescription Drug - Brand

$16

—

68968021503

XELSTRYM 13.5 MG/9 HR PATCH

Prescription Drug - Brand

$16

—

68968022003

XELSTRYM 18 MG/9 HR PATCH

Prescription Drug - Brand

$16

—

68968051408

COMBIPATCH 0.05-0.14 MG PTCH

Prescription Drug - Brand

$32

—

68968052508

COMBIPATCH 0.05-0.25 MG PTCH

Prescription Drug - Brand

$32

—

68968204001

PEXEVA 40 MG TABLET

Prescription Drug - Brand

$11

—

68968347508

ESTRADIOL 0.075 MG PATCH

Prescription Drug - Generic

$9

—

68968449201

LITHOBID 300 MG TABLET SA

Prescription Drug - Brand

$3

—

68968555203

DAYTRANA 10 MG/9 HR PATCH

Prescription Drug - Brand

$6

—

68968555303

DAYTRANA 15 MG/9 HR PATCH

Prescription Drug - Brand

$6

—

68968555403

DAYTRANA 20 MG/9 HOUR PATCH

Prescription Drug - Brand

$6

—

68968555503

DAYTRANA 30 MG/9 HOUR PATCH

Prescription Drug - Brand

$6

—

68968661008

MINIVELLE 0.1 MG PATCH

Prescription Drug - Brand

$12

—

68968662508

MINIVELLE 0.025 MG PATCH

Prescription Drug - Brand

$12

—

68968663708

MINIVELLE 0.0375 MG PATCH

Prescription Drug - Brand

$12

—

68968665008

MINIVELLE 0.05 MG PATCH

Prescription Drug - Brand

$12

—

68968667508

MINIVELLE 0.075 MG PATCH

Prescription Drug - Brand

$12

—

68992301003

ENVARSUS XR 1 MG TABLET

Prescription Drug - Brand

$6

—

69000

Drg xtrnl ear absc/hem smpl

Surgery - Auditory

$118

—

69005

Drg xtrnl ear absc/hem comp

Surgery - Auditory

$146

—

69020

Drg xtrnl aud canal abscess

Surgery - Auditory

$133

—

My Cost List