Medical Procedure Costs

65870

Incise inner eye adhesions

Surgery - Eye

$513

—

65875

Incise inner eye adhesions

Surgery - Eye

$548

—

65880

Incise inner eye adhesions

Surgery - Eye

$573

—

65900

Remove eye lesion

Surgery - Eye

$850

—

65920

Remove implant of eye

Surgery - Eye

$681

—

65930

Remove blood clot from eye

Surgery - Eye

$548

—

66020

Injection treatment of eye

Surgery - Eye

$114

—

66030

Injection treatment of eye

Surgery - Eye

$98

—

66130

Remove eye lesion

Surgery - Eye

$477

—

66150

Glaucoma surgery

Surgery - Eye

$761

—

66155

Glaucoma surgery

Surgery - Eye

$761

—

66160

Glaucoma surgery

Surgery - Eye

$848

—

66170

Glaucoma surgery

Surgery - Eye

$938

—

66172

Incision of eye

Surgery - Eye

$1,029

—

66174

Trluml dil aq o/f can w/o st

Surgery - Eye

$540

—

66175

Trluml dil aq o/f can w/st

Surgery - Eye

$620

—

66179

Aqueous shunt eye w/o graft

Surgery - Eye

$924

—

66180

Aqueous shunt eye w/graft

Surgery - Eye

$971

—

66183

Insert ant drainage device

Surgery - Eye

$881

—

66184

Revision of aqueous shunt

Surgery - Eye

$687

—

66185

Revise aqueous shunt eye

Surgery - Eye

$733

—

66220063731

SANCUSO 3.1 MG/24 HR PATCH

Prescription Drug - Brand

$669

—

66220071930

KRISTALOSE 10 GM PACKET

Prescription Drug - Brand

$10

—

66220072930

KRISTALOSE 20 GM PACKET

Prescription Drug - Brand

$10

—

66225

Repair/graft eye lesion

Surgery - Eye

$793

—

66250

Follow-up surgery of eye

Surgery - Eye

$478

—

66302046760

ADCIRCA 20 MG TABLET

Prescription Drug - Brand

$67

—

66424052035

AUROGUARD OTIC SOLUTION

Prescription Drug - Generic

$0

—

66435010184

RIBASPHERE 200 MG CAPSULE

Prescription Drug - Generic

$1

—

66435010216

RIBASPHERE 200 MG TABLET

Prescription Drug - Generic

$1

—

66490069010

MYSOLINE 50 MG TABLET

Prescription Drug - Brand

$12

—

66490069110

MYSOLINE 250 MG TABLET

Prescription Drug - Brand

$66

—

66500

Incision of iris

Surgery - Eye

$352

—

66505

Incision of iris

Surgery - Eye

$383

—

66530025830

FLUOROURACIL 0.5% CREAM

Prescription Drug - Generic

$48

—

66582031154

VYTORIN 10-10 MG TABLET

Prescription Drug - Brand

$11

—

66582032154

LIPTRUZET 10-20 MG TABLET

Prescription Drug - Brand

$5

—

66582032254

LIPTRUZET 10-40 MG TABLET

Prescription Drug - Brand

$5

—

66594099905

MAXIMUM D3 10,000 UNITS CAP

Prescription Drug - Generic

$1

—

66600

Remove iris and lesion

Surgery - Eye

$791

—

66605

Removal of iris

Surgery - Eye

$927

—

66625

Removal of iris

Surgery - Eye

$371

—

66630

Removal of iris

Surgery - Eye

$486

—

66635

Removal of iris

Surgery - Eye

$491

—

66658023428

KINERET 100 MG/0.67 ML SYRINGE

Prescription Drug - Brand

$192

—

66680

Repair iris & ciliary body

Surgery - Eye

$507

—

66682

Repair iris & ciliary body

Surgery - Eye

$566

—

66683

Implantation iris prosthesis

Surgery - Eye

$661

—

66685100101

AMOX TR-K CLV 875-125 MG TAB

Prescription Drug - Generic

$0

—

66685100202

AMOX TR-K CLV 500-125 MG TAB

Prescription Drug - Generic

$0

—

My Cost List