Medical Procedure Costs

00009768601

CAVERJECT 40 MCG VIAL

Prescription Drug - Brand

$125

—

00013010201

AZULFIDINE ENTAB 500 MG

Prescription Drug - Brand

$2

—

00013104201

ESTRING 7.5 MCG/DAY (2 MG) RING

Prescription Drug - Brand

$552

—

00013215036

ESTRING 2 MG VAGINAL RING

Prescription Drug - Brand

$524

—

00013262681

GENOTROPIN 5 MG CARTRIDGE

Prescription Drug - Brand

$748

—

00013264681

GENOTROPIN 12 MG CARTRIDGE

Prescription Drug - Brand

$1,810

—

00013264902

GENOTROPIN MINIQUICK 0.2 MG

Prescription Drug - Brand

$31

—

00013265002

GENOTROPIN MINIQUICK 0.4 MG

Prescription Drug - Brand

$62

—

00013265102

GENOTROPIN MINIQUICK 0.6 MG

Prescription Drug - Brand

$93

—

00013530117

MYCOBUTIN 150 MG CAPSULE

Prescription Drug - Brand

$31

—

0001U

Red blood cell typing

Pathology/Laboratory

$720

—

00023004210

TAZORAC 0.1% GEL

Prescription Drug - Brand

$14

—

00023010605

PRED-G 1% EYE DROPS

Prescription Drug - Brand

$17

—

00023031204

REFRESH LACRI-LUBE OINTMENT

Prescription Drug - Brand

$3

—

00023031304

BLEPHAMIDE EYE OINTMENT

Prescription Drug - Brand

$40

—

00023031604

FML S.O.P. 0.1% OINTMENT

Prescription Drug - Brand

$42

—

00023040370

REFRESH PLUS 0.5% EYE DROPS

Prescription Drug - Brand

$0

—

00023050650

REFRESH CLASSIC EYE DROPS

Prescription Drug - Brand

$0

—

00023066704

REFRESH P.M. OINTMENT

Prescription Drug - Brand

$2

—

00023079801

REFRESH TEARS 0.5% EYE DROPS

Prescription Drug - Brand

$0

—

00023079815

REFRESH TEARS 0.5% EYE DROP

Prescription Drug - Brand

$1

—

00023114501

BOTOX 100 UNITS VIAL

Prescription Drug - Brand

$598

—

00023218105

ACULAR 0.5% EYE DROPS

Prescription Drug - Brand

$53

—

00023311010

REFRESH TEARS PF 0.5-0.9% DROP

Prescription Drug - Brand

$1

—

00023320508

LUMIGAN 0.01% EYE DROPS

Prescription Drug - Brand

$103

—

00023324015

REFRESH OPTIVE EYE DROPS

Prescription Drug - Brand

$1

—

00023341630

REFRESH OPTIVE SENSITIVE DROPS

Prescription Drug - Brand

$0

—

00023350731

ACUVAIL 0.45% OPHTH SOLUTION

Prescription Drug - Brand

$11

—

00023361525

ZYMAXID 0.5% EYE DROPS

Prescription Drug - Brand

$67

—

00023361670

LATISSE 0.03% EYELASH SOLUTION

Prescription Drug - Brand

$41

—

00023367060

ACZONE 5% GEL

Prescription Drug - Brand

$11

—

00023378210

REFRESH RELIEVA PF XTRA DROP

Prescription Drug - Brand

$1

—

00023392102

BOTOX 200 UNITS VIAL

Prescription Drug - Brand

$1,156

—

00023429003

LASTACAFT 0.25% EYE DROPS

Prescription Drug - Brand

$76

—

00023429105

LASTACAFT ONCE DAILY 0.25% DRP

Prescription Drug - Brand

$3

—

00023449130

REFRESH OPTIVE ADVANCED DROPS

Prescription Drug - Brand

$0

—

00023451530

REFRESH RELIEVA PF 0.5-1% DROP

Prescription Drug - Brand

$0

—

00023455430

REFRESH CELLUVISC 1% EYE GEL

Prescription Drug - Brand

$0

—

00023485745

VANIQA 13.9% CREAM

Prescription Drug - Brand

$4

—

00023520690

ACZONE 7.5% GEL PUMP

Prescription Drug - Brand

$10

—

00023530105

RESTASIS MULTIDOSE 0.05% EYE

Prescription Drug - Brand

$112

—

00023545910

REFRESH OPTIVE GEL EYE DROPS

Prescription Drug - Brand

$1

—

00023577330

REFRESH OPTIVE MEGA-3 PF DROPS

Prescription Drug - Brand

$0

—

00023585318

DELZICOL DR 400 MG CAPSULE

Prescription Drug - Brand

$4

—

00023586111

GELNIQUE 10% GEL SACHET

Prescription Drug - Brand

$13

—

00023586230

TAYTULLA 1 MG-20 MCG CAPSULE

Prescription Drug - Brand

$9

—

00023587430

BYVALSON 5 MG-80 MG TABLET

Prescription Drug - Brand

$4

—

00023590118

ASACOL HD DR 800 MG TABLET

Prescription Drug - Brand

$9

—

00023599060

ANDRODERM 2 MG/24HR PATCH

Prescription Drug - Brand

$10

—

00023599230

ANDRODERM 4 MG/24HR PATCH

Prescription Drug - Brand

$20

—

My Cost List