Medical Procedure Costs

49428

Ligation of shunt

Surgery - Digestive

$412

—

49429

Removal of shunt

Surgery - Digestive

$435

—

49435

Insert subq exten to ip cath

Surgery - Digestive

$106

—

49436

Embedded ip cath exit-site

Surgery - Digestive

$178

—

49440

Place gastrostomy tube perc

Surgery - Digestive

$178

—

49441

Place duod/jej tube perc

Surgery - Digestive

$217

—

49442

Place cecostomy tube perc

Surgery - Digestive

$178

—

49446

Change g-tube to g-j perc

Surgery - Digestive

$126

—

49450

Replace g/c tube perc

Surgery - Digestive

$56

—

49451

Replace duod/jej tube perc

Surgery - Digestive

$76

—

49452

Replace g-j tube perc

Surgery - Digestive

$117

—

49460

Fix g/colon tube w/device

Surgery - Digestive

$43

—

49465

Fluoro exam of g/colon tube

Surgery - Digestive

$26

—

49483000310

LAXATIVE EC 5 MG TABLET

Prescription Drug - Generic

$0

—

49483000355

BISACODYL EC 5 MG TABLET

Prescription Drug - Generic

$0

—

49483006110

ALLER-G-TIME 25 MG CAPLET

Prescription Drug - Generic

$0

—

49483008010

SENNA-TIME 8.6 MG TABLET

Prescription Drug - Generic

$0

—

49483008110

SENNA-TIME S TABLET

Prescription Drug - Generic

$0

—

49483024210

ALLERGY-TIME 4 MG TABLET

Prescription Drug - Generic

$0

—

49483027206

MUCOSA 400 MG TABLET

Prescription Drug - Generic

$0

—

49483028006

MUCOSA DM 400-20 MG TABLET

Prescription Drug - Generic

$0

—

49483033010

MINIPRIN EC 81 MG TABLET

Prescription Drug - Generic

$0

—

49483033310

MOTION-TIME 25 MG TABLET CHEW

Prescription Drug - Generic

$0

—

49483037000

EXTRA PAIN RELIEF CAPLET

Prescription Drug - Generic

$0

—

49483068201

ALLERGY RLF (CETRZN) 5 MG TAB

Prescription Drug - Generic

$0

—

49491

Rpr hern preemie reduc

Surgery - Digestive

$764

—

49492

Rpr ing hern premie blocked

Surgery - Digestive

$911

—

49495

Rpr ing hernia baby reduc

Surgery - Digestive

$399

—

49496

Rpr ing hernia baby blocked

Surgery - Digestive

$596

—

49500

Rpr ing hernia init reduce

Surgery - Digestive

$413

—

49501

Rpr ing hernia init blocked

Surgery - Digestive

$587

—

49502010102

EPINEPHRINE 0.15 MG AUTO-INJCT

Prescription Drug - Generic

$143

—

49502010202

EPINEPHRINE 0.3 MG AUTO-INJECT

Prescription Drug - Generic

$142

—

49502019580

SEMGLEE 100 UNIT/ML VIAL

Prescription Drug - Brand

$9

—

49502019675

SEMGLEE 100 UNIT/ML PEN

Prescription Drug - Brand

$10

—

49502050001

EPIPEN 0.3 MG AUTO-INJECTOR

Prescription Drug - Brand

$290

—

49502050002

EPIPEN 2-PAK 0.3 MG AUTO-INJCT

Prescription Drug - Brand

$290

—

49502050101

EPIPEN JR 0.15 MG AUTO-INJECTR

Prescription Drug - Brand

$291

—

49502050102

EPIPEN JR 2-PAK 0.15 MG INJCTR

Prescription Drug - Brand

$291

—

49502060561

PERFOROMIST 20 MCG/2 ML SOLN

Prescription Drug - Brand

$10

—

49502080693

YUPELRI 175 MCG/3 ML SOLUTION

Prescription Drug - Brand

$17

—

49502090030

EMSAM 6 MG/24 HOURS PATCH

Prescription Drug - Brand

$75

—

49502090130

EMSAM 9 MG/24 HOURS PATCH

Prescription Drug - Brand

$75

—

49502090230

EMSAM 12 MG/24 HOURS PATCH

Prescription Drug - Brand

$75

—

49505

Prp i/hern init reduc >5 yr

Surgery - Digestive

$508

—

49507

Prp i/hern init block >5 yr

Surgery - Digestive

$568

—

49520

Rerepair ing hernia reduce

Surgery - Digestive

$608

—

49521

Rerepair ing hernia blocked

Surgery - Digestive

$685

—

49525

Repair ing hernia sliding

Surgery - Digestive

$554

—

49540

Repair lumbar hernia

Surgery - Digestive

$644

—

My Cost List