Medical Procedure Costs

58925

Removal of ovarian cyst(s)

Surgery - Female Genital

$698

—

58940

Removal of ovary(s)

Surgery - Female Genital

$515

—

58943

Removal of ovary(s)

Surgery - Female Genital

$1,130

—

58950

Resect ovarian malignancy

Surgery - Female Genital

$1,068

—

58951

Resect ovarian malignancy

Surgery - Female Genital

$1,331

—

58952

Resect ovarian malignancy

Surgery - Female Genital

$1,520

—

58953

Tah rad dissect for debulk

Surgery - Female Genital

$1,845

—

58954

Tah rad debulk/lymph remove

Surgery - Female Genital

$1,995

—

58956

Bso omentectomy w/tah

Surgery - Female Genital

$1,261

—

58958

Resc recr ovr tbl pp utr mal

Surgery - Female Genital

$1,453

—

58960

Exploration of abdomen

Surgery - Female Genital

$944

—

58970

Retrieval of oocyte

Surgery - Female Genital

$173

—

58976

Transfer of embryo

Surgery - Female Genital

$186

—

58980015022

HYPERCARE 20% SOLUTION

Prescription Drug - Generic

$0

—

58980033690

ZENCIA WASH

Prescription Drug - Generic

$0

—

58980047210

MELQUIN HP 4% CREAM

Prescription Drug - Generic

$1

—

58980047310

MELPAQUE HP 4% CREAM

Prescription Drug - Generic

$1

—

58980047610

MELQUIN-3 SOLUTION

Prescription Drug - Generic

$0

—

58980057410

NUQUIN HP 4% CREAM

Prescription Drug - Generic

$1

—

58980062380

X-VIATE 40% LOTION

Prescription Drug - Generic

$0

—

58980062415

X-VIATE 40% GEL

Prescription Drug - Generic

$1

—

58980062570

X-VIATE 40% CREAM

Prescription Drug - Generic

$0

—

58980063014

SALACYN 6% LOTION

Prescription Drug - Generic

$0

—

58980063190

SALACYN 6% CREAM

Prescription Drug - Generic

$0

—

58980081110

DERMAZENE CREAM

Prescription Drug - Generic

$1

—

59000

Amniocentesis diagnostic

Surgery - Maternity

$73

—

59001

Amniocentesis therapeutic

Surgery - Maternity

$160

—

59011025530

INTERMEZZO 3.5 MG TAB SUBLING

Prescription Drug - Brand

$12

—

59011025630

INTERMEZZO 1.75 MG TAB SUBLING

Prescription Drug - Brand

$12

—

59011026125

MS CONTIN CR 30 MG TABLET

Prescription Drug - Brand

$7

—

59011026210

MS CONTIN 60 MG TABLET

Prescription Drug - Brand

$13

—

59011026310

MS CONTIN 100 MG TABLET

Prescription Drug - Brand

$19

—

59011027160

HYSINGLA ER 20 MG TABLET

Prescription Drug - Brand

$13

—

59011027260

HYSINGLA ER 30 MG TABLET

Prescription Drug - Brand

$19

—

59011027360

HYSINGLA ER 40 MG TABLET

Prescription Drug - Brand

$26

—

59011027460

HYSINGLA ER 60 MG TABLET

Prescription Drug - Brand

$36

—

59011027560

HYSINGLA ER 80 MG TABLET

Prescription Drug - Brand

$49

—

59011027660

HYSINGLA ER 100 MG TABLET

Prescription Drug - Brand

$62

—

59011041010

OXYCONTIN 10 MG TABLET

Prescription Drug - Brand

$4

—

59011041020

OXYCONTIN ER 10 MG TABLET

Prescription Drug - Brand

$6

—

59011041520

OXYCONTIN ER 15 MG TABLET

Prescription Drug - Brand

$9

—

59011042020

OXYCONTIN ER 20 MG TABLET

Prescription Drug - Brand

$11

—

59011043010

OXYCONTIN 30 MG TABLET

Prescription Drug - Brand

$9

—

59011043020

OXYCONTIN ER 30 MG TABLET

Prescription Drug - Brand

$15

—

59011044020

OXYCONTIN ER 40 MG TABLET

Prescription Drug - Brand

$19

—

59011045101

DILAUDID 5 MG/5 ML ORAL LIQUID

Prescription Drug - Brand

$1

—

59011046020

OXYCONTIN ER 60 MG TABLET

Prescription Drug - Brand

$27

—

59011048010

OXYCONTIN 80 MG TABLET

Prescription Drug - Brand

$20

—

59011048020

OXYCONTIN ER 80 MG TABLET

Prescription Drug - Brand

$33

—

59011075004

BUTRANS 5 MCG/HR PATCH

Prescription Drug - Brand

$49

—

My Cost List