Medical Procedure Costs

63481081360

OPANA ER 7.5 MG TABLET

Prescription Drug - Brand

$4

—

63481081460

OPANA ER 10 MG TABLET

Prescription Drug - Brand

$5

—

63481081560

OPANA ER 15 MG TABLET

Prescription Drug - Brand

$7

—

63481081660

OPANA ER 20 MG TABLET

Prescription Drug - Brand

$9

—

63481081760

OPANA ER 30 MG TABLET

Prescription Drug - Brand

$12

—

63481081860

OPANA ER 40 MG TABLET

Prescription Drug - Brand

$16

—

63600

Remove spinal cord lesion

Surgery - Nervous

$1,085

—

63610

Stimulation of spinal cord

Surgery - Nervous

$549

—

63620

Srs spinal lesion

Surgery - Nervous

$1,113

—

63621

Srs spinal lesion addl

Surgery - Nervous

$231

—

63646004060

CALCIPOTRIENE-BETAMETHASONE DP 0.005%-0.064% SUSPENSION

Prescription Drug - Generic

$2

—

63650

Implant neuroelectrodes

Surgery - Nervous

$375

—

63655

Implant neuroelectrodes

Surgery - Nervous

$839

—

63661

Remove spine eltrd perq aray

Surgery - Nervous

$309

—

63662

Remove spine eltrd plate

Surgery - Nervous

$850

—

63663

Revise spine eltrd perq aray

Surgery - Nervous

$410

—

63664

Revise spine eltrd plate

Surgery - Nervous

$886

—

63685

Ins/rplc spi npg/rcvr pocket

Surgery - Nervous

$319

—

63688

Rev/rmv imp sp npg/r dtch cn

Surgery - Nervous

$306

—

63700

Repair of spinal herniation

Surgery - Nervous

$1,323

—

63702

Repair of spinal herniation

Surgery - Nervous

$1,435

—

63704

Repair of spinal herniation

Surgery - Nervous

$1,670

—

63706

Repair of spinal herniation

Surgery - Nervous

$1,839

—

63707

Repair spinal fluid leakage

Surgery - Nervous

$928

—

63709

Repair spinal fluid leakage

Surgery - Nervous

$1,085

—

63710

Graft repair of spine defect

Surgery - Nervous

$1,046

—

63717032630

NASOHIST PEDIATRIC DROPS

Prescription Drug - Brand

$1

—

63717033108

BICLORA LIQUID

Prescription Drug - Brand

$0

—

63717087001

ARBINOXA 4 MG TABLET

Prescription Drug - Generic

$0

—

63717087116

ARBINOXA 4 MG/5 ML LIQUID

Prescription Drug - Generic

$0

—

63717087516

REZIRA SOLUTION

Prescription Drug - Brand

$1

—

63717087616

ZUTRIPRO SOLUTION

Prescription Drug - Brand

$1

—

63717090201

REPREXAIN 10-200 MG TABLET

Prescription Drug - Generic

$3

—

63717091002

ELIPHOS 667 MG TABLET

Prescription Drug - Generic

$0

—

63739006702

MUCUS RELIEF ER 600 MG TABLET

Prescription Drug - Generic

$0

—

63739016056

NYSTATIN 500,000 UNIT/5 ML CUP

Prescription Drug - Generic

$0

—

63739017024

LIDOCAINE HCL 1% 50 MG/5 ML VL

Prescription Drug - Generic

$1

—

63739028310

DILTIAZEM 24HR CD 120 MG CAP

Prescription Drug - Generic

$0

—

63739045510

HYDROCODONE-ACETAMINOPHEN 5 MG-500 MG TABLET

Prescription Drug - Generic

$0

—

63739047810

DOCUSATE SODIUM 100 MG CAPSULE

Prescription Drug - Generic

$0

—

63739048610

HYDROXYZINE HCL 25 MG TABLET

Prescription Drug - Generic

$0

—

63740

Install spinal shunt

Surgery - Nervous

$1,009

—

63741

Install spinal shunt

Surgery - Nervous

$713

—

63744

Revision of spinal shunt

Surgery - Nervous

$736

—

63746

Removal of spinal shunt

Surgery - Nervous

$643

—

63801010701

BENSAL HP 3% OINTMENT

Prescription Drug - Brand

$28

—

63824001466

MUCINEX SEVERE CONGES-COUGH LQ

Prescription Drug - Brand

$0

—

63824001566

MUCINEX COLD-FLU-SORETHROAT LQ

Prescription Drug - Brand

$0

—

63824001764

CHILD'S MUCINEX COLD-FEVER LIQ

Prescription Drug - Brand

$0

—

63824002066

MUCINEX FAST-MAX SEV COLD LIQ

Prescription Drug - Brand

$0

—

My Cost List