Medical Procedure Costs

65205

Remove foreign body from eye

Surgery - Eye

$24

—

65210

Remove foreign body from eye

Surgery - Eye

$30

—

65219059601

TYENNE 162 MG/0.9 ML AUTOINJCT

Prescription Drug - Brand

$822

—

65219061299

ADALIMUMAB-AACF(CF) PEN 40 MG/0.8 ML (2 PACK)

Prescription Drug - Generic

$872

—

65220

Remove foreign body from eye

Surgery - Eye

$38

—

65222

Remove foreign body from eye

Surgery - Eye

$42

—

65224031060

ZOHYDRO ER 10 MG CAPSULE

Prescription Drug - Brand

$10

—

65224031560

ZOHYDRO ER 15 MG CAPSULE

Prescription Drug - Brand

$10

—

65224032060

ZOHYDRO ER 20 MG CAPSULE

Prescription Drug - Brand

$10

—

65224033060

ZOHYDRO ER 30 MG CAPSULE

Prescription Drug - Brand

$11

—

65224034060

ZOHYDRO ER 40 MG CAPSULE

Prescription Drug - Brand

$11

—

65224035060

ZOHYDRO ER 50 MG CAPSULE

Prescription Drug - Brand

$11

—

65224053930

PEDIATEX TD LIQUID

Prescription Drug - Generic

$1

—

65224070711

OMECLAMOX-PAK COMBO PACK

Prescription Drug - Brand

$7

—

65235

Remove foreign body from eye

Surgery - Eye

$636

—

65260

Remove foreign body from eye

Surgery - Eye

$840

—

65265

Remove foreign body from eye

Surgery - Eye

$942

—

65270

Repair of eye wound

Surgery - Eye

$119

—

65272

Repair of eye wound

Surgery - Eye

$300

—

65273

Repair of eye wound

Surgery - Eye

$321

—

65275

Repair of eye wound

Surgery - Eye

$389

—

65280

Repair of eye wound

Surgery - Eye

$566

—

65285

Repair of eye wound

Surgery - Eye

$929

—

65286

Repair of eye wound

Surgery - Eye

$420

—

65290

Repair of eye socket wound

Surgery - Eye

$415

—

65400

Removal of eye lesion

Surgery - Eye

$523

—

65410

Biopsy of cornea

Surgery - Eye

$87

—

65420

Removal of eye lesion

Surgery - Eye

$335

—

65426

Removal of eye lesion

Surgery - Eye

$413

—

65430

Corneal smear

Surgery - Eye

$86

—

65435

Curette/treat cornea

Surgery - Eye

$60

—

65436

Curette/treat cornea

Surgery - Eye

$318

—

65450

Treatment of corneal lesion

Surgery - Eye

$289

—

65483089403

LOTRONEX 0.5 MG TABLET

Prescription Drug - Brand

$29

—

65483089503

LOTRONEX 1 MG TABLET

Prescription Drug - Brand

$57

—

65580059401

METADATE ER 20 MG TABLET

Prescription Drug - Generic

$1

—

65597011190

AZOR 10-20 MG TABLET

Prescription Drug - Brand

$8

—

65597011490

TRIBENZOR 20-5-12.5 MG TABLET

Prescription Drug - Brand

$8

—

65597011690

TRIBENZOR 40-5-25 MG TABLET

Prescription Drug - Brand

$10

—

65597011730

TRIBENZOR 40-10-12.5 MG TABLET

Prescription Drug - Brand

$11

—

65597020230

SAVAYSA 30 MG TABLET

Prescription Drug - Brand

$15

—

65597020330

SAVAYSA 60 MG TABLET

Prescription Drug - Brand

$15

—

65597030110

MORPHABOND ER 15 MG TABLET

Prescription Drug - Brand

$5

—

65597030210

MORPHABOND ER 30 MG TABLET

Prescription Drug - Brand

$11

—

65597090230

WELCHOL 3.75G PACKET

Prescription Drug - Brand

$22

—

65600

Revision of cornea

Surgery - Eye

$300

—

65628005301

FIRST-MARY'S MOUTHWASH

Prescription Drug - Brand

$0

—

65628020510

FIRVANQ 25 MG/ML SOLUTION

Prescription Drug - Brand

$0

—

65628020605

FIRVANQ 50 MG/ML SOLUTION

Prescription Drug - Brand

$1

—

65628027210

KONVOMEP 2-84 MG/ML ORAL SUSP

Prescription Drug - Brand

$1

—

My Cost List