Medical Procedure Costs

17271

Dstr mal les s/n/h/f/g 0.6-1

Surgery - Integumentary

$89

—

17272

Dstr mal les s/n/h/f/g 1.1-2

Surgery - Integumentary

$102

—

17273

Dstr mal les s/n/h/f/g 2.1-3

Surgery - Integumentary

$115

—

17274

Dstr mal les s/n/h/f/g 3.1-4

Surgery - Integumentary

$139

—

17276

Dstr mal les s/n/h/f/g >4.0

Surgery - Integumentary

$168

—

17280

Dstr mal ls f/e/e/n/l/m .5/<

Surgery - Integumentary

$74

—

17281

Dstr mal ls f/e/e/n/l/m .6-1

Surgery - Integumentary

$100

—

17282

Dstr mal ls f/e/e/n/l/m1.1-2

Surgery - Integumentary

$114

—

17283

Dstr mal ls f/e/e/n/l/m2.1-3

Surgery - Integumentary

$141

—

17284

Dstr mal ls f/e/e/n/l/m3.1-4

Surgery - Integumentary

$165

—

17286

Dstr mal ls f/e/e/n/l/m>4.0

Surgery - Integumentary

$224

—

17311

Mohs 1 stage h/n/hf/g

Surgery - Integumentary

$287

—

17312

Mohs addl stage

Surgery - Integumentary

$153

—

17313

Mohs 1 stage t/a/l

Surgery - Integumentary

$258

—

17314

Mohs addl stage t/a/l

Surgery - Integumentary

$140

—

17315

Mohs surg addl block

Surgery - Integumentary

$40

—

17340

Cryotherapy for acne

Surgery - Integumentary

$42

—

17350001505

RESCULA 0.15% EYE DROPS

Prescription Drug - Brand

$25

—

17360

Chemical exfoliation acne

Surgery - Integumentary

$77

—

17433987605

ENEMEEZ MINI ENEMA

Prescription Drug - Brand

$0

—

17433987703

ENEMEEZ PLUS MINI ENEMA

Prescription Drug - Brand

$0

—

17478006012

ARTIFICIAL TEARS 1.4% DROPS

Prescription Drug - Generic

$0

—

17478006235

AKWA TEARS OINTMENT

Prescription Drug - Generic

$1

—

17478010610

LEVOFLOXACIN 0.5% EYE DROPS

Prescription Drug - Generic

$8

—

17478017424

XOPENEX 1.25 MG/3 ML SOLUTION

Prescription Drug - Brand

$3

—

17478021412

ATROPINE CARE 1% EYE DROPS

Prescription Drug - Generic

$2

—

17478021612

NAPHAZOLINE 0.1% EYE DROPS

Prescription Drug - Generic

$0

—

17478023835

AK-POLY-BAC EYE OINTMENT

Prescription Drug - Generic

$3

—

17478028310

GENTAK 3 MG/ML EYE DROPS

Prescription Drug - Generic

$1

—

17478028435

GENTAK 0.3 % EYE OINTMENT

Prescription Drug - Generic

$8

—

17478029010

TOBRAMYCIN 0.3% EYE DROPS

Prescription Drug - Generic

$1

—

17478045016

LORTAB 10 MG-300 MG/15 ML ELXR

Prescription Drug - Brand

$0

—

17478060930

ZIOPTAN 0.0015% EYE DROPS

Prescription Drug - Brand

$7

—

17772010130

TROKENDI XR 25 MG CAPSULE

Prescription Drug - Brand

$12

—

17772010230

TROKENDI XR 50 MG CAPSULE

Prescription Drug - Brand

$16

—

17772010330

TROKENDI XR 100 MG CAPSULE

Prescription Drug - Brand

$32

—

17772010430

TROKENDI XR 200 MG CAPSULE

Prescription Drug - Brand

$44

—

17772012101

OXTELLAR XR 150 MG TABLET

Prescription Drug - Brand

$9

—

17772012201

OXTELLAR XR 300 MG TABLET

Prescription Drug - Brand

$13

—

17772012301

OXTELLAR XR 600 MG TABLET

Prescription Drug - Brand

$23

—

17772013130

QELBREE ER 100 MG CAPSULE

Prescription Drug - Brand

$13

—

17772013230

QELBREE ER 150 MG CAPSULE

Prescription Drug - Brand

$13

—

17772013360

QELBREE ER 200 MG CAPSULE

Prescription Drug - Brand

$13

—

18657011704

HYLENEX 150 UNITS/ML VIAL

Prescription Drug - Brand

$53

—

18860010210

FAZACLO 25 MG ODT

Prescription Drug - Brand

$4

—

18860010401

FAZACLO 100 MG ODT

Prescription Drug - Brand

$15

—

18860010610

FAZACLO 200 MG ODT

Prescription Drug - Brand

$28

—

19000

Puncture aspir cyst breast

Surgery - Integumentary

$36

—

19001

Puncture aspir cyst brst ea

Surgery - Integumentary

$18

—

19020

Mastotomy expl drg absc dp

Surgery - Integumentary

$316

—

My Cost List