Medical Procedure Costs

69727

Rmv ntr oi imp sk tc esp<100

Surgery - Auditory

$469

—

69728

Rmv ntr oi imp sk tc>=100

Surgery - Auditory

$520

—

69729

Impl oi implt sk tc esp>=100

Surgery - Auditory

$589

—

69730

Rplc oi implt sk tc esp>=100

Surgery - Auditory

$598

—

69740

Repair facial nerve

Surgery - Auditory

$1,019

—

69745

Repair facial nerve

Surgery - Auditory

$1,088

—

69751010012

PHEXXI 1.8-1-0.4% VAGINAL GEL

Prescription Drug - Brand

$6

—

69751040001

SOLOSEC 2 GM GRANULE PACKET

Prescription Drug - Brand

$283

—

69784010201

TRIPROLIDINE 0.625 MG/ML DROP

Prescription Drug - Generic

$1

—

69784024330

ACIPHEX DR 20 MG TABLET

Prescription Drug - Brand

$25

—

69784042012

LOVAZA 1 GM CAPSULE

Prescription Drug - Brand

$8

—

69784050001

EC-NAPROXEN DR 500 MG TABLET

Prescription Drug - Generic

$2

—

69784050101

EC-NAPROXEN DR 375 MG TABLET

Prescription Drug - Generic

$0

—

69784071215

AVODART 0.5 MG SOFTGEL

Prescription Drug - Brand

$22

—

69801

Incise inner ear

Surgery - Auditory

$108

—

69805

Explore inner ear

Surgery - Auditory

$907

—

69806

Explore inner ear

Surgery - Auditory

$816

—

69809012605

CLOZARIL 25 MG TABLET

Prescription Drug - Brand

$6

—

69809012705

CLOZARIL 100 MG TABLET

Prescription Drug - Brand

$16

—

69905

Remove inner ear

Surgery - Auditory

$819

—

69910

Remove inner ear & mastoid

Surgery - Auditory

$874

—

69915

Incise inner ear nerve

Surgery - Auditory

$1,309

—

69918010101

DESMOPRESSIN ACETATE 0.1 MG TB

Prescription Drug - Generic

$0

—

69918020101

DESMOPRESSIN ACETATE 0.2 MG TB

Prescription Drug - Generic

$0

—

69918035030

LAMOTRIGINE ODT 25 MG TABLET

Prescription Drug - Generic

$1

—

69918036030

LAMOTRIGINE ODT 50 MG TABLET

Prescription Drug - Generic

$1

—

69918037030

LAMOTRIGINE ODT 100 MG TABLET

Prescription Drug - Generic

$2

—

69918038030

LAMOTRIGINE ODT 200 MG TABLET

Prescription Drug - Generic

$2

—

69918051505

NEOMYC-POLYM-DEXAMETH EYE DROP

Prescription Drug - Generic

$2

—

69930

Implant cochlear device

Surgery - Auditory

$1,060

—

69950

Incise inner ear nerve

Surgery - Auditory

$1,511

—

69955

Release facial nerve

Surgery - Auditory

$1,707

—

69960

Release inner ear canal

Surgery - Auditory

$1,633

—

69970

Remove inner ear lesion

Surgery - Auditory

$1,842

—

69973010590

FENOFIBRIC ACID 105 MG TABLET

Prescription Drug - Generic

$2

—

69990

Microsurgery add-on

Other

$198

—

70000000202

NASAL DECONGESTANT 30 MG TAB

Prescription Drug - Generic

$0

—

70000000801

CHILD MUCUS-COUGH 5-100 MG/5 ML

Prescription Drug - Generic

$0

—

70000000901

MICONAZOLE-7 CREAM

Prescription Drug - Generic

$0

—

70000001001

REDNESS RELIEF EYE DROPS

Prescription Drug - Generic

$0

—

70000001101

ARTIFICIAL TEARS DROPS

Prescription Drug - Generic

$0

—

70000001202

LUBRICANT 0.5% EYE DROPS

Prescription Drug - Generic

$0

—

70000001801

EYE WASH IRRIGATING SOLUTION

Prescription Drug - Generic

$0

—

70000002001

ETHYL RUBBING ALCOHOL 70% LIQ

Prescription Drug - Generic

$0

—

70000002101

EPSOM SALT

Prescription Drug - Generic

$0

—

70000002301

ITCH RELIEF 2%-0.1% SPRAY

Prescription Drug - Generic

$0

—

70000002401

CASTOR OIL

Prescription Drug - Generic

$0

—

70000003401

ANTACID 500 MG CHEW TABLET

Prescription Drug - Generic

$0

—

70000003501

ASPIRIN EC 325 MG TABLET

Prescription Drug - Generic

$0

—

70000004101

LICE TREATMENT 1% CREME RINSE

Prescription Drug - Generic

$0

—

My Cost List