Medical Procedure Costs

50742054905

FENTANYL 12 MCG/HR PATCH

Prescription Drug - Generic

$10

—

50742055005

FENTANYL 25 MCG/HR PATCH

Prescription Drug - Generic

$6

—

50742055105

FENTANYL 37.5 MCG/HR PATCH

Prescription Drug - Generic

$36

—

50742055205

FENTANYL 50 MCG/HR PATCH

Prescription Drug - Generic

$9

—

50742055405

FENTANYL 75 MCG/HR PATCH

Prescription Drug - Generic

$15

—

50742055605

FENTANYL 100 MCG/HR PATCH

Prescription Drug - Generic

$19

—

50742065984

DOLISHALE 90-20 MCG TABLET

Prescription Drug - Generic

$1

—

50750

Fusion of ureter & kidney

Surgery - Urinary

$1,030

—

50760

Ureteroureterostomy

Surgery - Urinary

$1,027

—

50770

Splicing of ureters

Surgery - Urinary

$1,030

—

50780

Reimplant ureter in bladder

Surgery - Urinary

$1,007

—

50782

Reimplant ureter in bladder

Surgery - Urinary

$963

—

50783

Reimplant ureter in bladder

Surgery - Urinary

$1,008

—

50785

Reimplant ureter in bladder

Surgery - Urinary

$1,085

—

50800

Implant ureter in bowel

Surgery - Urinary

$832

—

50810

Fusion of ureter & bowel

Surgery - Urinary

$1,330

—

50815

Urine shunt to intestine

Surgery - Urinary

$1,097

—

50820

Construct bowel bladder

Surgery - Urinary

$1,179

—

50825

Construct bowel bladder

Surgery - Urinary

$1,464

—

50830

Revise urine flow

Surgery - Urinary

$1,599

—

50840

Replace ureter by bowel

Surgery - Urinary

$1,104

—

50844032907

ALLERGY (DIPHEN) 25 MG MINITAB

Prescription Drug - Generic

$0

—

50845

Appendico-vesicostomy

Surgery - Urinary

$1,129

—

50860

Transplant ureter to skin

Surgery - Urinary

$850

—

50881000705

OPZELURA 1.5% CREAM

Prescription Drug - Brand

$34

—

50900

Repair of ureter

Surgery - Urinary

$761

—

50920

Closure ureter/skin fistula

Surgery - Urinary

$795

—

50930

Closure ureter/bowel fistula

Surgery - Urinary

$986

—

50940

Release of ureter

Surgery - Urinary

$801

—

50945

Laparoscopy ureterolithotomy

Surgery - Urinary

$867

—

50947

Laparo new ureter/bladder

Surgery - Urinary

$1,234

—

50948

Laparo new ureter/bladder

Surgery - Urinary

$1,131

—

50951

Endoscopy of ureter

Surgery - Urinary

$269

—

50953

Endoscopy of ureter

Surgery - Urinary

$288

—

50955

Ureter endoscopy & biopsy

Surgery - Urinary

$310

—

50957

Ureter endoscopy & treatment

Surgery - Urinary

$311

—

50961

Ureter endoscopy & treatment

Surgery - Urinary

$279

—

50967012630

IROSPAN 24/6 TABLET

Prescription Drug - Generic

$4

—

50967021990

NESTABS TABLET

Prescription Drug - Brand

$2

—

50967031730

NESTABS DHA COMBO PACK

Prescription Drug - Brand

$2

—

50970

Ureter endoscopy

Surgery - Urinary

$325

—

50972

Ureter endoscopy & catheter

Surgery - Urinary

$314

—

50974

Ureter endoscopy & biopsy

Surgery - Urinary

$414

—

50976

Ureter endoscopy & treatment

Surgery - Urinary

$408

—

50980

Ureter endoscopy & treatment

Surgery - Urinary

$312

—

50991012116

POLYTUSSIN DM 2-15-7.5 MG/5 ML

Prescription Drug - Generic

$0

—

50991013216

POLYTUSSIN DM 7.5-5-12.5 MG/5 ML

Prescription Drug - Generic

$0

—

50991021401

POLY-VENT DM TABLET

Prescription Drug - Generic

$1

—

50991021601

POLY HIST FORTE 7.5-10 MG TAB

Prescription Drug - Generic

$1

—

50991022016

POLY-HIST DM LIQUID

Prescription Drug - Generic

$0

—

My Cost List