Medical Procedure Costs

24130

Excision radial head

Surgery - Musculoskeletal

$485

—

24134

Sequestrectomy shft/dstl hum

Surgery - Musculoskeletal

$703

—

24136

Sequestrectomy radial h/n

Surgery - Musculoskeletal

$601

—

24138

Sequestrectomy olecrn proces

Surgery - Musculoskeletal

$661

—

24140

Partial exc bone humerus

Surgery - Musculoskeletal

$656

—

24145

Prtl exc bone radial h/n

Surgery - Musculoskeletal

$566

—

24147

Prtl exc bone olecrn process

Surgery - Musculoskeletal

$597

—

24149

Radical resection of elbow

Surgery - Musculoskeletal

$1,090

—

24150

Rad rescj tum dstl/shft hum

Surgery - Musculoskeletal

$1,397

—

24152

Rad resection tum radial h/n

Surgery - Musculoskeletal

$1,224

—

24155

Resection of elbow joint

Surgery - Musculoskeletal

$791

—

24160

Rmvl prosthhumrl&ulnar cmpnt

Surgery - Musculoskeletal

$1,148

—

24164

Removal prosth radial head

Surgery - Musculoskeletal

$682

—

24200

Rmvl fb upper arm/elbw subq

Surgery - Musculoskeletal

$143

—

24201

Rmvl fb upper arm/elbw deep

Surgery - Musculoskeletal

$392

—

24208000401

ISTALOL 0.5% EYE DROPS

Prescription Drug - Brand

$80

—

24208027615

MURO-128 2% EYE DROPS

Prescription Drug - Brand

$1

—

24208027715

MURO-128 5% EYE DROPS

Prescription Drug - Brand

$1

—

24208029910

LOTEMAX 0.5% EYE DROPS

Prescription Drug - Brand

$62

—

24208031705

SULF-PRED 10-0.23% EYE DROPS

Prescription Drug - Generic

$3

—

24208034205

DESMOPRESSIN 0.01% SOLUTION

Prescription Drug - Generic

$24

—

24208035310

ALREX 0.2% EYE DROPS

Prescription Drug - Brand

$58

—

24208035805

ZYLET EYE DROPS

Prescription Drug - Brand

$64

—

24208037705

MIEBO 100% EYE DROP

Prescription Drug - Brand

$264

—

24208038555

MURO-128 5% EYE OINTMENT

Prescription Drug - Brand

$5

—

24208044335

LOTEMAX 0.5% EYE OINTMENT

Prescription Drug - Brand

$100

—

24208044605

BESIVANCE 0.6% SUSP

Prescription Drug - Brand

$44

—

24208046415

BRINZOLAMIDE 1% EYE DROPS

Prescription Drug - Generic

$12

—

24208049968

TIMOPTIC 0.5% OCUDOSE DROP

Prescription Drug - Brand

$10

—

24208050307

LOTEMAX 0.5% OPHTHALMIC GEL

Prescription Drug - Brand

$50

—

24208050405

VYZULTA 0.024% OPHTH SOLUTION

Prescription Drug - Brand

$102

—

24208050505

LEVOBUNOLOL 0.5% EYE DROPS

Prescription Drug - Generic

$3

—

24208050707

LOTEMAX SM 0.38% OPHTH GEL

Prescription Drug - Brand

$49

—

24208053535

ZIRGAN 0.15% OPHTHALMIC GEL

Prescription Drug - Brand

$91

—

24208053725

LUMIFY 0.025% EYE DROP

Prescription Drug - Brand

$2

—

24208055555

BACITRACIN-POLYMYXIN EYE OINT

Prescription Drug - Generic

$3

—

24208058060

GENTAMICIN 0.3% EYE DROPS

Prescription Drug - Generic

$1

—

24208058564

TROPICAMIDE 1% EYE DROP

Prescription Drug - Generic

$0

—

24208060105

CHILD'S ALAWAY 0.025% EYE DROP

Prescription Drug - Brand

$2

—

24208060110

ALAWAY 0.025% EYE DROPS

Prescription Drug - Brand

$1

—

24208060203

PROLENSA 0.07% EYE DROPS

Prescription Drug - Brand

$116

—

24208061577

ACETIC ACID-ALUMINUM DROPS

Prescription Drug - Generic

$1

—

24208062902

BEPREVE 1.5% EYE DROPS

Prescription Drug - Brand

$56

—

24208063110

NEOMYCIN-POLYMYXIN-HC EAR SOLN

Prescription Drug - Generic

$5

—

24208067004

SULFACETAMIDE 10% EYE DROPS

Prescription Drug - Generic

$2

—

24208071510

PREDNISOLONE SOD 1% EYE DROP

Prescription Drug - Generic

$5

—

24208072002

DEXAMETHASONE 0.1% EYE DROP

Prescription Drug - Generic

$8

—

24208073506

CYCLOPENTOLATE 1% EYE DROP

Prescription Drug - Generic

$1

—

24208078055

NEOMYC-BACIT-POLYMIX EYE OINT

Prescription Drug - Generic

$5

—

24208078555

NEO-BACIT-POLY-HC EYE OINTMENT

Prescription Drug - Generic

$6

—

My Cost List