Medical Procedure Costs

57160

Insert pessary/other device

Surgery - Female Genital

$40

—

57170

Fitting of diaphragm/cap

Surgery - Female Genital

$41

—

57180

Treat vaginal bleeding

Surgery - Female Genital

$107

—

57200

Repair of vagina

Surgery - Female Genital

$305

—

57210

Repair vagina/perineum

Surgery - Female Genital

$355

—

57220

Revision of urethra

Surgery - Female Genital

$312

—

57230

Repair of urethral lesion

Surgery - Female Genital

$373

—

57237000114

LANSOPRAZOL-AMOXICIL-CLARITHRO

Prescription Drug - Generic

$6

—

57237018390

PRAMIPEXOLE 0.75 MG TABLET

Prescription Drug - Generic

$0

—

57237030416

ACETAMINOPHEN 160 MG/5 ML SOLN

Prescription Drug - Generic

$0

—

57237031251

GUAIFENESIN-DM 100-10 MG/5 ML CUP

Prescription Drug - Generic

$0

—

57237032552

GLYCERIN 2 GM SUPPOSITORY

Prescription Drug - Generic

$0

—

57237032652

CHILD GLYCERIN 1.2 GM SUPP

Prescription Drug - Generic

$0

—

57237032721

BISACODYL 10 MG SUPPOSITORY

Prescription Drug - Generic

$0

—

57237033042

URO-PAIN 99.5 MG TABLET

Prescription Drug - Generic

$0

—

57237033103

URO-PAIN 95 MG TABLET

Prescription Drug - Generic

$0

—

57237033242

URO-PAIN DUAL 162-162.5 MG TAB

Prescription Drug - Generic

$0

—

57237033721

PROCTOZONE-B 10 MG SUPPOSITORY

Prescription Drug - Generic

$0

—

57237033921

PROCTOZONE-GMAX 2 GM SUPPOSIT

Prescription Drug - Generic

$0

—

57237034912

ASPIRIN EC 81 MG TABLET

Prescription Drug - Generic

$0

—

57240

Anterior colporrhaphy

Surgery - Female Genital

$545

—

57250

Repair rectum & vagina

Surgery - Female Genital

$545

—

57260

Cmbn ant pst colprhy

Surgery - Female Genital

$687

—

57265

Cmbn ap colprhy w/ntrcl rpr

Surgery - Female Genital

$768

—

57267

Insert mesh/pelvic flr addon

Surgery - Female Genital

$219

—

57268

Repair of bowel bulge

Surgery - Female Genital

$457

—

57270

Repair of bowel pouch

Surgery - Female Genital

$721

—

57280

Suspension of vagina

Surgery - Female Genital

$857

—

57282

Colpopexy extraperitoneal

Surgery - Female Genital

$615

—

57283

Colpopexy intraperitoneal

Surgery - Female Genital

$619

—

57284

Repair paravag defect open

Surgery - Female Genital

$738

—

57285

Repair paravag defect vag

Surgery - Female Genital

$615

—

57287

Revise/remove sling repair

Surgery - Female Genital

$660

—

57288

Repair bladder defect

Surgery - Female Genital

$664

—

57289

Repair bladder & vagina

Surgery - Female Genital

$700

—

57291

Construction of vagina

Surgery - Female Genital

$488

—

57292

Construct vagina with graft

Surgery - Female Genital

$731

—

57295

Revise vag graft via vagina

Surgery - Female Genital

$449

—

57296

Revise vag graft open abd

Surgery - Female Genital

$843

—

57300

Repair rectum-vagina fistula

Surgery - Female Genital

$564

—

57305

Repair rectum-vagina fistula

Surgery - Female Genital

$899

—

57307

Fistula repair & colostomy

Surgery - Female Genital

$998

—

57308

Fistula repair transperine

Surgery - Female Genital

$631

—

57310

Repair urethrovaginal lesion

Surgery - Female Genital

$449

—

57311

Repair urethrovaginal lesion

Surgery - Female Genital

$504

—

57320

Repair bladder-vagina lesion

Surgery - Female Genital

$502

—

57330

Repair bladder-vagina lesion

Surgery - Female Genital

$689

—

57335

Repair vagina

Surgery - Female Genital

$1,036

—

57400

Dilation of vagina

Surgery - Female Genital

$116

—

57410

Pelvic examination

Surgery - Female Genital

$97

—

My Cost List