Medical Procedure Costs

65130

Insert ocular implant

Surgery - Eye

$762

—

65135

Insert ocular implant

Surgery - Eye

$770

—

65140

Attach ocular implant

Surgery - Eye

$825

—

65150

Revise ocular implant

Surgery - Eye

$630

—

65155

Reinsert ocular implant

Surgery - Eye

$855

—

65162005010

OXYCODONE HCL (IR) 20 MG TAB

Prescription Drug - Generic

$0

—

65162008774

ITRACONAZOLE 10 MG/ML SOLUTION

Prescription Drug - Generic

$1

—

65162012608

LYLLANA 0.025 MG PATCH

Prescription Drug - Generic

$7

—

65162014808

LYLLANA 0.0375 MG PATCH

Prescription Drug - Generic

$7

—

65162014908

LYLLANA 0.05 MG PATCH

Prescription Drug - Generic

$7

—

65162015008

LYLLANA 0.075 MG PATCH

Prescription Drug - Generic

$7

—

65162022623

YUVAFEM 10 MCG VAGINAL INSERT

Prescription Drug - Generic

$7

—

65162022808

LYLLANA 0.1 MG PATCH

Prescription Drug - Generic

$7

—

65162025350

RANITIDINE 150 MG TABLET

Prescription Drug - Generic

$0

—

65162031684

LOMEDIA 24 FE 1 MG-20 MCG TAB

Prescription Drug - Generic

$1

—

65162032109

NIACIN ER 500 MG TABLET

Prescription Drug - Generic

$0

—

65162032309

NIACIN ER 1,000 MG TABLET

Prescription Drug - Generic

$0

—

65162033991

DAPSONE 5% GEL

Prescription Drug - Generic

$1

—

65162034784

ZENCHENT FE TABLET CHEWABLE

Prescription Drug - Generic

$2

—

65162035803

ZAFEMY 150-35 MCG/DAY PATCH

Prescription Drug - Generic

$32

—

65162041503

BUPRENORPHINE-NALOXONE 8-2 MG TABLET SL

Prescription Drug - Generic

$6

—

65162041603

BUPRENORPHINE-NALOXONE 2-0.5 MG TABLET SL

Prescription Drug - Generic

$4

—

65162046935

ELURYNG VAGINAL RING

Prescription Drug - Generic

$50

—

65162055410

DEMECLOCYCLINE 150 MG TABLET

Prescription Drug - Generic

$3

—

65162055548

DEMECLOCYCLINE 300 MG TABLET

Prescription Drug - Generic

$6

—

65162055858

TAYSOFY 1 MG-20 MCG CAPSULE

Prescription Drug - Generic

$1

—

65162057110

BETHANECHOL 5 MG TABLET

Prescription Drug - Generic

$0

—

65162057210

BETHANECHOL 10 MG TABLET

Prescription Drug - Generic

$0

—

65162057310

BETHANECHOL 25 MG TABLET

Prescription Drug - Generic

$0

—

65162057410

BETHANECHOL 50 MG TABLET

Prescription Drug - Generic

$0

—

65162065990

NIZATIDINE 15 MG/ML SOLUTION

Prescription Drug - Generic

$1

—

65162067384

RISPERIDONE 1 MG/ML SOLUTION

Prescription Drug - Generic

$0

—

65162068090

PROMETHAZINE-DM SOLUTION

Prescription Drug - Generic

$0

—

65162068784

LORAZEPAM 2 MG/ML ORAL CONCENT

Prescription Drug - Generic

$1

—

65162069179

ONDANSETRON 4 MG/5 ML SOLUTION

Prescription Drug - Generic

$0

—

65162070588

ESCITALOPRAM OXALATE 5 MG/5 ML

Prescription Drug - Generic

$0

—

65162070684

AZELASTINE 0.15% NASAL SPRAY

Prescription Drug - Generic

$1

—

65162075009

DUTASTERIDE 0.5 MG CAPSULE

Prescription Drug - Generic

$0

—

65162075150

BENAZEPRIL HCL 5 MG TABLET

Prescription Drug - Generic

$0

—

65162077810

BUDESONIDE EC 3 MG CAPSULE

Prescription Drug - Generic

$1

—

65162079108

LIDOCAINE 5% PATCH

Prescription Drug - Generic

$2

—

65162089023

OLOPATADINE 665 MCG NASAL SPRY

Prescription Drug - Generic

$1

—

65162089129

MOMETASONE FUROATE 50 MCG SPRY

Prescription Drug - Generic

$2

—

65162095703

ESOMEPRAZOLE DR 49.3 MG CAP

Prescription Drug - Generic

$2

—

65162098908

DOTTI 0.025 MG PATCH

Prescription Drug - Generic

$7

—

65162099208

DOTTI 0.0375 MG PATCH

Prescription Drug - Generic

$7

—

65162099308

DOTTI 0.05 MG PATCH

Prescription Drug - Generic

$7

—

65162099508

DOTTI 0.075 MG PATCH

Prescription Drug - Generic

$7

—

65162099708

DOTTI 0.1 MG PATCH

Prescription Drug - Generic

$7

—

65175

Removal of ocular implant

Surgery - Eye

$699

—

My Cost List