Medical Procedure Costs

50458094101

INVOKAMET XR 50-1,000 MG TAB

Prescription Drug - Brand

$10

—

50458094201

INVOKAMET XR 150-500 MG TABLET

Prescription Drug - Brand

$10

—

50458094301

INVOKAMET XR 150-1,000 MG TAB

Prescription Drug - Brand

$10

—

50474000148

KEPPRA 100 MG/ML ORAL SOLN

Prescription Drug - Brand

$2

—

50474037066

BRIVIACT 10 MG TABLET

Prescription Drug - Brand

$24

—

50474047066

BRIVIACT 25 MG TABLET

Prescription Drug - Brand

$24

—

50474050015

NAYZILAM 5 MG NASAL SPRAY

Prescription Drug - Brand

$328

—

50474057066

BRIVIACT 50 MG TABLET

Prescription Drug - Brand

$24

—

50474059440

KEPPRA 250 MG TABLET

Prescription Drug - Brand

$8

—

50474059540

KEPPRA 500 MG TABLET

Prescription Drug - Brand

$10

—

50474059640

KEPPRA 750 MG TABLET

Prescription Drug - Brand

$13

—

50474059766

KEPPRA 1,000 MG TABLET

Prescription Drug - Brand

$20

—

50474059866

KEPPRA XR 500 MG TABLET

Prescription Drug - Brand

$9

—

50474059966

KEPPRA XR 750 MG TABLET

Prescription Drug - Brand

$14

—

50474067066

BRIVIACT 75 MG TABLET

Prescription Drug - Brand

$24

—

50474071079

CIMZIA 2X200 MG/ML SYRINGE KIT

Prescription Drug - Brand

$6,112

—

50474071081

CIMZIA 2X200 MG/ML(X3)START KT

Prescription Drug - Brand

$6,073

—

50474077066

BRIVIACT 100 MG TABLET

Prescription Drug - Brand

$24

—

50474078185

BIMZELX 160 MG/ML AUTOINJECTOR

Prescription Drug - Brand

$8,113

—

50474078284

BIMZELX 320 MG/2 ML AUTOINJECT

Prescription Drug - Brand

$8,068

—

50474080103

NEUPRO 1 MG/24 HR PATCH

Prescription Drug - Brand

$28

—

50474080203

NEUPRO 2 MG/24 HR PATCH

Prescription Drug - Brand

$28

—

50474080303

NEUPRO 3 MG/24 HR PATCH

Prescription Drug - Brand

$28

—

50474080403

NEUPRO 4 MG/24 HR PATCH

Prescription Drug - Brand

$28

—

50474080503

NEUPRO 6 MG/24 HR PATCH

Prescription Drug - Brand

$28

—

50474080603

NEUPRO 8 MG/24 HR PATCH

Prescription Drug - Brand

$28

—

50474087015

BRIVIACT 10 MG/ML ORAL SOLN

Prescription Drug - Brand

$5

—

50474090750

LORTAB 7.5-500 TABLET

Prescription Drug - Brand

$2

—

50474091060

LORTAB 10-500 TABLET

Prescription Drug - Brand

$2

—

50474093001

LORTAB 5-325 MG TABLET

Prescription Drug - Brand

$2

—

50474093101

LORTAB 7.5-325 MG TABLET

Prescription Drug - Brand

$2

—

50474093201

LORTAB 10-325 MG TABLET

Prescription Drug - Brand

$3

—

50484001090

SANTYL OINTMENT

Prescription Drug - Brand

$8

—

50484032800

SECURA ANTIFUNGAL 2% CREAM

Prescription Drug - Generic

$0

—

50484081015

REGRANEX 0.01% GEL

Prescription Drug - Brand

$79

—

50500

Repair of kidney wound

Surgery - Urinary

$1,210

—

50520

Close kidney-skin fistula

Surgery - Urinary

$1,095

—

50525

Close nephrovisceral fistula

Surgery - Urinary

$1,379

—

50526

Close nephrovisceral fistula

Surgery - Urinary

$1,473

—

50540

Revision of horseshoe kidney

Surgery - Urinary

$1,025

—

50541

Laparo ablate renal cyst

Surgery - Urinary

$821

—

50542

Laparo ablate renal mass

Surgery - Urinary

$1,045

—

50543

Laparo partial nephrectomy

Surgery - Urinary

$1,330

—

50544

Laparoscopy pyeloplasty

Surgery - Urinary

$1,103

—

50545

Laparo radical nephrectomy

Surgery - Urinary

$1,186

—

50546

Laparoscopic nephrectomy

Surgery - Urinary

$1,079

—

50547

Laparo removal donor kidney

Surgery - Urinary

$1,540

—

50548

Laparo remove w/ureter

Surgery - Urinary

$1,191

—

50551

Kidney endoscopy

Surgery - Urinary

$260

—

50553

Kidney endoscopy

Surgery - Urinary

$277

—

My Cost List