Medical Procedure Costs

50327

Prep renal graft/venous

Surgery - Urinary

$195

—

50328

Prep renal graft/arterial

Surgery - Urinary

$170

—

50329

Prep renal graft/ureteral

Surgery - Urinary

$163

—

50340

Recipient nephrectomy

Surgery - Urinary

$938

—

50360

Rnl altrnsplj w/o rcp nfrct

Surgery - Urinary

$2,293

—

50365

Rnl altrnsplj w/rcp nfrct

Surgery - Urinary

$2,800

—

50370

Rmvl transplanted rnl algrft

Surgery - Urinary

$1,170

—

50380

Rnl autotrnsplj rimpltj kdn

Surgery - Urinary

$1,979

—

50382

Change ureter stent percut

Surgery - Urinary

$217

—

50383001804

EYE WASH-IRRIGATING SOLN

Prescription Drug - Generic

$0

—

50383004316

HYDROCODONE-HOMATROPINE SYRUP

Prescription Drug - Generic

$0

—

50383008716

GUAIATUSSIN AC LIQUID

Prescription Drug - Generic

$0

—

50383016716

VITAMIN C 500 MG/5 ML SYRUP

Prescription Drug - Generic

$0

—

50383028793

BUPRENORPHIN-NALOXON 8-2 MG SL

Prescription Drug - Generic

$5

—

50383058766

NYSTATIN 100,000 UNITS/ML SUSP

Prescription Drug - Generic

$0

—

50383061804

LOPERAMIDE 1 MG/5 ML LIQUID

Prescription Drug - Generic

$0

—

50383074120

ALBUTEROL 5 MG/ML SOLUTION

Prescription Drug - Generic

$2

—

50383077116

DOCU LIQUID 50 MG/5 ML

Prescription Drug - Generic

$0

—

50383080216

PROMETHAZINE-PHENYLEPHRINE SYR

Prescription Drug - Generic

$0

—

50383080516

PROMETHAZINE-PE-CODEINE SYRUP

Prescription Drug - Generic

$0

—

50383085516

PAREGORIC LIQUID

Prescription Drug - Generic

$1

—

50384

Remove ureter stent percut

Surgery - Urinary

$196

—

50385

Change stent via transureth

Surgery - Urinary

$189

—

50386

Remove stent via transureth

Surgery - Urinary

$144

—

50387

Change nephroureteral cath

Surgery - Urinary

$72

—

50389

Remove renal tube w/fluoro

Surgery - Urinary

$46

—

50390

Drainage of kidney lesion

Surgery - Urinary

$81

—

50391

Instll rx agnt into rnal tub

Surgery - Urinary

$85

—

50396

Measure kidney pressure

Surgery - Urinary

$100

—

50400

Revision of kidney/ureter

Surgery - Urinary

$1,033

—

50405

Revision of kidney/ureter

Surgery - Urinary

$1,244

—

50419010510

BETAPACE 80 MG TABLET

Prescription Drug - Brand

$10

—

50419010910

BETAPACE 120 MG TABLET

Prescription Drug - Brand

$15

—

50419011506

BETAPACE AF 80 MG TABLET

Prescription Drug - Brand

$10

—

50419011906

BETAPACE AF 120 MG TABLET

Prescription Drug - Brand

$15

—

50419040203

YASMIN 28 TABLET

Prescription Drug - Brand

$4

—

50419040303

SAFYRAL TABLET

Prescription Drug - Brand

$7

—

50419040503

YAZ 28 TABLET

Prescription Drug - Brand

$6

—

50419040703

BEYAZ 28 TABLET

Prescription Drug - Brand

$8

—

50419040903

NATAZIA 28 TABLET

Prescription Drug - Brand

$8

—

50419045104

CLIMARA 0.05 MG/DAY PATCH

Prescription Drug - Brand

$18

—

50419045204

CLIMARA 0.1 MG/DAY PATCH

Prescription Drug - Brand

$18

—

50419045304

CLIMARA 0.075 MG/DAY PATCH

Prescription Drug - Brand

$18

—

50419045404

CLIMARA 0.025 MG/DAY PATCH

Prescription Drug - Brand

$18

—

50419045504

MENOSTAR 14 MCG/DAY PATCH

Prescription Drug - Brand

$39

—

50419045604

CLIMARA 0.0375 MG/DAY PATCH

Prescription Drug - Brand

$18

—

50419045904

CLIMARA 0.06 MG/DAY PATCH

Prescription Drug - Brand

$18

—

50419048203

ANGELIQ 0.25 MG-0.5 MG TABLET

Prescription Drug - Brand

$6

—

50419048303

ANGELIQ 0.5 MG-1 MG TABLET

Prescription Drug - Brand

$6

—

50419049104

CLIMARA PRO PATCH

Prescription Drug - Brand

$60

—

My Cost List