Medical Procedure Costs

36800046965

STOMACH RELIEF 262 MG TAB CHEW

Prescription Drug - Generic

$0

—

36800047847

ANTACID CALCIUM 500 MG CHW TAB

Prescription Drug - Generic

$0

—

36800051626

TUSSIN CF COUGH & COLD LIQ

Prescription Drug - Generic

$0

—

36800057953

CHILD FEVER REDUCER 120 MG SUP

Prescription Drug - Generic

$0

—

36800058840

ANTACID PLUS ANTI-GAS SUSP

Prescription Drug - Generic

$0

—

36800059523

CALCIUM ANTACID 1,000 MG TAB

Prescription Drug - Generic

$0

—

36800064526

LOPERAMIDE 1 MG/7.5 ML SUSP

Prescription Drug - Generic

$0

—

36800064810

NASAL FOUR 1% NASAL SPRAY

Prescription Drug - Generic

$0

—

36800082949

PAIN RELIEF PM GELCAP

Prescription Drug - Generic

$0

—

36800090326

CHILDREN'S PLUS M-S COLD SUSP

Prescription Drug - Generic

$0

—

36800090626

CHILDREN'S COLD-ALLERGY ELIXIR

Prescription Drug - Generic

$0

—

36800095062

HEARTBURN RELIEF 150 MG TABLET

Prescription Drug - Generic

$0

—

36800097760

NITE TIME COLD-FLU RLF SOFTGEL

Prescription Drug - Generic

$0

—

36800098726

CHILDREN'S COLD & COUGH ELIXIR

Prescription Drug - Generic

$0

—

36810

Insertion of cannula

Surgery - Cardiovascular

$177

—

36815

Insertion of cannula

Surgery - Cardiovascular

$123

—

36818

Av fuse uppr arm cephalic

Surgery - Cardiovascular

$629

—

36819

Av fuse uppr arm basilic

Surgery - Cardiovascular

$664

—

36820

Av fusion/forearm vein

Surgery - Cardiovascular

$664

—

36821

Av fusion direct any site

Surgery - Cardiovascular

$601

—

36823

Insertion of cannula(s)

Surgery - Cardiovascular

$1,317

—

36825

Artery-vein autograft

Surgery - Cardiovascular

$721

—

36830

Artery-vein nonautograft

Surgery - Cardiovascular

$607

—

36831

Open thrombect av fistula

Surgery - Cardiovascular

$566

—

36832

Av fistula revision open

Surgery - Cardiovascular

$688

—

36833

Av fistula revision

Surgery - Cardiovascular

$736

—

36835

Insertion thomas shunt

Surgery - Cardiovascular

$477

—

36836

Prq av fstl crtj uxtr 1 acs

Surgery - Cardiovascular

$314

—

36837

Prq av fstl crt uxtr sep acs

Surgery - Cardiovascular

$401

—

36838

Dist revas ligation hemo

Surgery - Cardiovascular

$1,030

—

36860

External cannula declotting

Surgery - Cardiovascular

$98

—

36861

Cannula declotting

Surgery - Cardiovascular

$124

—

36901

Intro cath dialysis circuit

Surgery - Cardiovascular

$147

—

36902

Intro cath dialysis circuit

Surgery - Cardiovascular

$210

—

36903

Intro cath dialysis circuit

Surgery - Cardiovascular

$278

—

36904

Thrmbc/nfs dialysis circuit

Surgery - Cardiovascular

$321

—

36905

Thrmbc/nfs dialysis circuit

Surgery - Cardiovascular

$386

—

36906

Thrmbc/nfs dialysis circuit

Surgery - Cardiovascular

$445

—

36907

Balo angiop ctr dialysis seg

Surgery - Cardiovascular

$128

—

36908

Stent plmt ctr dialysis seg

Surgery - Cardiovascular

$182

—

36909

Dialysis circuit embolj

Surgery - Cardiovascular

$176

—

37000001624

PEPTO-BISMOL TO-GO 262 MG CHEW

Prescription Drug - Brand

$0

—

37000001806

PEPTO-BISMOL TABLET CHEW

Prescription Drug - Brand

$0

—

37000002304

METAMUCIL PACKET

Prescription Drug - Brand

$0

—

37000002305

METAMUCIL POWDER

Prescription Drug - Brand

$0

—

37000002401

METAMUCIL SUGAR-FREE POWDER

Prescription Drug - Brand

$0

—

37000002404

METAMUCIL FIBER SINGLES PACKET

Prescription Drug - Brand

$0

—

37000003203

PEPTO-BISMOL SUSPENSION

Prescription Drug - Brand

$0

—

37000040445

VICKS QLEARQUIL ALLERGY 10 MG

Prescription Drug - Brand

$1

—

37000040824

VICKS QLEARQUIL NIGHT LIQUICAP

Prescription Drug - Brand

$0

—

My Cost List