Medical Procedure Costs

58657032350

TRI-VITE-FLUORIDE 0.25 MG/ML

Prescription Drug - Generic

$0

—

58657032750

MULTIVIT-FLUOR-IRON 0.25 MG/ML

Prescription Drug - Generic

$0

—

58657045401

ME-NAPHOS-MB-HYO 1 TABLET

Prescription Drug - Generic

$4

—

58657045601

URO-MP CAPSULE

Prescription Drug - Generic

$2

—

58657046802

SULFACETAMIDE-SULFUR 10-5% CRM

Prescription Drug - Generic

$1

—

58657047316

SULFACETAMIDE-SULFUR 9-4% CLSR

Prescription Drug - Generic

$0

—

58657047416

SOD SULFACE-SULFUR 9-4.5% WASH

Prescription Drug - Generic

$0

—

58657047716

SODIUM SULFACETAMIDE 10% WASH

Prescription Drug - Generic

$0

—

58657048903

UREA 40% CREAM

Prescription Drug - Generic

$0

—

58657050508

GUAIFENESIN-DM 100-10 MG/5 ML

Prescription Drug - Generic

$0

—

58657050916

GUAIFENESIN 100 MG/5 ML LIQUID

Prescription Drug - Generic

$0

—

58657052516

M-PAP 160 MG/5 ML LIQUID

Prescription Drug - Generic

$0

—

58657052816

M-DRYL 12.5 MG/5 ML SOLUTION

Prescription Drug - Generic

$0

—

58657053530

M-HIST PD 0.625 MG/ML DROP

Prescription Drug - Generic

$1

—

58657081021

PYRIDOSTIGMINE BR 30 MG TABLET

Prescription Drug - Generic

$7

—

58660

Laparoscopy lysis

Surgery - Female Genital

$628

—

58661

Laparoscopy remove adnexa

Surgery - Female Genital

$586

—

58662

Laparoscopy excise lesions

Surgery - Female Genital

$647

—

58670

Laparoscopy tubal cautery

Surgery - Female Genital

$333

—

58671

Laparoscopy tubal block

Surgery - Female Genital

$333

—

58672

Laparoscopy fimbrioplasty

Surgery - Female Genital

$645

—

58673

Laparoscopy salpingostomy

Surgery - Female Genital

$700

—

58674

Laps abltj uterine fibroids

Surgery - Female Genital

$720

—

58700

Removal of fallopian tube

Surgery - Female Genital

$730

—

58720

Removal of ovary/tube(s)

Surgery - Female Genital

$698

—

58740

Adhesiolysis tube ovary

Surgery - Female Genital

$825

—

58750

Repair oviduct

Surgery - Female Genital

$802

—

58752

Revise ovarian tube(s)

Surgery - Female Genital

$799

—

58760

Fimbrioplasty

Surgery - Female Genital

$724

—

58770

Create new tubal opening

Surgery - Female Genital

$760

—

58800

Drainage of ovarian cyst(s)

Surgery - Female Genital

$282

—

58805

Drainage of ovarian cyst(s)

Surgery - Female Genital

$381

—

58809036301

CHLORPHEN SR 12 MG TABLET

Prescription Drug - Generic

$0

—

58809037504

Z-BUM 22% DIAPER RASH CREAM

Prescription Drug - Generic

$0

—

58809050130

VANAHIST PD 0.625 MG/ML DROP

Prescription Drug - Generic

$1

—

58809055508

VANACOF DM 18-200-10 MG/15 ML

Prescription Drug - Brand

$0

—

58809065008

VANALICE GEL

Prescription Drug - Brand

$0

—

58809072530

ACTIVE FE TABLET

Prescription Drug - Generic

$3

—

58809082960

ESCAVITE D TABLET CHEWABLE

Prescription Drug - Generic

$2

—

58809088801

ESCAVITE TABLET CHEWABLE

Prescription Drug - Generic

$1

—

58809099901

VANACOF LIQUID

Prescription Drug - Brand

$0

—

58820

Drain ovary abscess open

Surgery - Female Genital

$304

—

58822

Drain ovary abscess percut

Surgery - Female Genital

$633

—

58825

Transposition ovary(s)

Surgery - Female Genital

$628

—

58900

Biopsy of ovary(s)

Surgery - Female Genital

$389

—

58914017014

CARAFATE 1 GM/10 ML SUSP

Prescription Drug - Brand

$1

—

58914017110

CARAFATE 1 GM TABLET

Prescription Drug - Brand

$5

—

58914030180

RECTIV 0.4% OINTMENT

Prescription Drug - Brand

$21

—

58914050156

CANASA 1,000 MG SUPPOSITORY

Prescription Drug - Brand

$37

—

58920

Partial removal of ovary(s)

Surgery - Female Genital

$631

—

My Cost List