Medical Procedure Costs

53436008430

VELTASSA 8.4 GM POWDER PACKET

Prescription Drug - Brand

$34

—

53436016830

VELTASSA 16.8 GM POWDER PACKET

Prescription Drug - Brand

$34

—

53440

Male sling procedure

Surgery - Urinary

$681

—

53442

Remove/revise male sling

Surgery - Urinary

$716

—

53444

Insert tandem cuff

Surgery - Urinary

$717

—

53445

Insert uro/ves nck sphincter

Surgery - Urinary

$689

—

53446

Remove uro sphincter

Surgery - Urinary

$587

—

53447

Remove/replace ur sphincter

Surgery - Urinary

$731

—

53448

Remov/replc ur sphinctr comp

Surgery - Urinary

$1,143

—

53449

Repair uro sphincter

Surgery - Urinary

$559

—

53450

Revision of urethra

Surgery - Urinary

$379

—

53451010101

HORIZANT ER 600 MG TABLET

Prescription Drug - Brand

$18

—

53451010301

HORIZANT ER 300 MG TABLET

Prescription Drug - Brand

$18

—

53460

Revision of urethra

Surgery - Urinary

$422

—

53489037601

TRIMETHOBENZAMIDE 300 MG CAP

Prescription Drug - Generic

$1

—

53489047801

SULINDAC 150 MG TABLET

Prescription Drug - Generic

$0

—

53489047901

SULINDAC 200 MG TABLET

Prescription Drug - Generic

$0

—

53489067707

FENOFIBRIC ACID 35 MG TABLET

Prescription Drug - Generic

$1

—

53500

Urethrlys transvag w/ scope

Surgery - Urinary

$673

—

53502

Repair of urethra injury

Surgery - Urinary

$447

—

53505

Repair of urethra injury

Surgery - Urinary

$447

—

53510

Repair of urethra injury

Surgery - Urinary

$576

—

53515

Repair of urethra injury

Surgery - Urinary

$718

—

53520

Repair of urethra defect

Surgery - Urinary

$512

—

53600

Dilate urethra stricture

Surgery - Urinary

$56

—

53601

Dilate urethra stricture

Surgery - Urinary

$48

—

53605

Dilate urethra stricture

Surgery - Urinary

$56

—

53620

Dilate urethra stricture

Surgery - Urinary

$77

—

53621

Dilate urethra stricture

Surgery - Urinary

$64

—

536515026

ANTI-FUNGAL 1% POWDER

Prescription Drug - Generic

$0

—

53660

Dilation of urethra

Surgery - Urinary

$37

—

53661

Dilation of urethra

Surgery - Urinary

$36

—

53665

Dilation of urethra

Surgery - Urinary

$33

—

53746011305

HYDROCODONE-ACETAMINOPHEN 7.5-650 TAB

Prescription Drug - Generic

$0

—

53746011410

HYDROCODONE-ACETAMINOPHEN 10-650 TABLET

Prescription Drug - Generic

$0

—

53746011701

HYDROCODONE-IBUPROFEN 10-200

Prescription Drug - Generic

$3

—

53746014501

HYDROCODONE-IBUPROFEN 7.5-200

Prescription Drug - Generic

$0

—

53746014601

HYDROCODONE-IBUPROFEN 5-200 MG

Prescription Drug - Generic

$3

—

53746020305

OXYCODONE-ACETAMINOPHEN 5-325 MG TAB

Prescription Drug - Generic

$0

—

53746020501

OXYCODONE-ACETAMINOPHEN 7.5-500 MG TAB

Prescription Drug - Generic

$0

—

53746020601

OXYCODONE-ACETAMINOPHEN 10-650 MG TAB

Prescription Drug - Generic

$0

—

53850

Prostatic microwave thermotx

Surgery - Urinary

$331

—

53852

Prostatic rf thermotx

Surgery - Urinary

$354

—

53854

Trurl dstrj prst8 tiss rf wv

Surgery - Urinary

$354

—

53855

Insert prost urethral stent

Surgery - Urinary

$72

—

53860

Transurethral rf treatment

Surgery - Urinary

$202

—

53865

Cysto insj dev ischmc rmdlg

Surgery - Urinary

$146

—

53866

Cathj rmvl dev ischmc rmdlg

Surgery - Urinary

$74

—

54000

Slitting of prepuce

Surgery - Male Genital

$105

—

54001

Slitting of prepuce

Surgery - Male Genital

$130

—

My Cost List