Medical Procedure Costs

64872

Subsequent repair of nerve

Surgery - Nervous

$100

—

64874

Repair & revise nerve add-on

Surgery - Nervous

$149

—

64876

Repair nerve/shorten bone

Surgery - Nervous

$168

—

64885

Nerve graft head/neck <4 cm

Surgery - Nervous

$929

—

64886

Nerve graft head/neck >4 cm

Surgery - Nervous

$1,118

—

64890

Nrv grf 1strnd hnd/foot <4cm

Surgery - Nervous

$980

—

64891

Nrv grf 1strnd hnd/foot >4cm

Surgery - Nervous

$1,041

—

64892

Nrv grf 1strnd arm/leg <4cm

Surgery - Nervous

$955

—

64893

Nrv grf 1strnd arm/leg >4 cm

Surgery - Nervous

$1,016

—

64895

Nrv grf mltst hnd/foot <4 cm

Surgery - Nervous

$1,192

—

64896

Nrv grf mltst hnd/foot >4 cm

Surgery - Nervous

$1,286

—

64896008412

ZOMIG 5 MG NASAL SPRAY

Prescription Drug - Brand

$110

—

64896066101

RYTARY ER 23.75 MG-95 MG CAP

Prescription Drug - Brand

$4

—

64896066201

RYTARY ER 36.25 MG-145 MG CAP

Prescription Drug - Brand

$4

—

64896066301

RYTARY ER 48.75 MG-195 MG CAP

Prescription Drug - Brand

$4

—

64896066401

RYTARY ER 61.25 MG-245 MG CAP

Prescription Drug - Brand

$5

—

64896066930

EMVERM 100 MG TABLET CHEW

Prescription Drug - Brand

$711

—

64896067151

ZOMIG 2.5 MG TABLET

Prescription Drug - Brand

$90

—

64896067250

ZOMIG 5 MG TABLET

Prescription Drug - Brand

$94

—

64896067410

DEXEDRINE SPANSULE 10 MG

Prescription Drug - Brand

$22

—

64896068251

ZOMIG 2.5 MG NASAL SPRAY

Prescription Drug - Brand

$78

—

64896069151

ZOMIG ZMT 2.5 MG TABLET

Prescription Drug - Brand

$91

—

64896069250

ZOMIG ZMT 5 MG TABLET

Prescription Drug - Brand

$95

—

64896069513

OXYMORPHONE HCL ER 5 MG TABLET

Prescription Drug - Generic

$5

—

64896069613

OXYMORPHONE HCL ER 7.5 MG TAB

Prescription Drug - Generic

$7

—

64896069713

OXYMORPHONE HCL ER 10 MG TAB

Prescription Drug - Generic

$9

—

64896069813

OXYMORPHONE HCL ER 15 MG TAB

Prescription Drug - Generic

$13

—

64896069913

OXYMORPHONE HCL ER 20 MG TAB

Prescription Drug - Generic

$16

—

64896070013

OXYMORPHONE HCL ER 30 MG TAB

Prescription Drug - Generic

$23

—

64896070113

OXYMORPHONE HCL ER 40 MG TAB

Prescription Drug - Generic

$30

—

64896096716

CREXONT ER 35 MG-140 MG CAP

Prescription Drug - Brand

$4

—

64896096816

CREXONT ER 52.5 MG-210 MG CAP

Prescription Drug - Brand

$4

—

64896096916

CREXONT ER 70 MG-280 MG CAP

Prescription Drug - Brand

$4

—

64896097016

CREXONT ER 87.5 MG-350 MG CAP

Prescription Drug - Brand

$4

—

64897

Nrv grf mltst arm/leg <4 cm

Surgery - Nervous

$1,142

—

64898

Nrv grf mltst arm/leg >4 cm

Surgery - Nervous

$1,237

—

64901

Nerve graft add-on

Surgery - Nervous

$509

—

64902

Nerve graft add-on

Surgery - Nervous

$589

—

64905

Nerve pedicle transfer

Surgery - Nervous

$891

—

64907

Nerve pedicle transfer

Surgery - Nervous

$1,169

—

64910

Nerve repair w/allograft

Surgery - Nervous

$697

—

64911

Neurorraphy w/vein autograft

Surgery - Nervous

$950

—

64912

Nrv rpr w/nrv algrft 1st

Surgery - Nervous

$819

—

64913

Nrv rpr w/nrv algrft ea addl

Surgery - Nervous

$147

—

64950020610

HYDROCODONE-HOMATROPINE 5-1.5 MG TABLET

Prescription Drug - Generic

$1

—

64950021101

CARBINOXAMINE MALEATE 4 MG TAB

Prescription Drug - Generic

$0

—

64950021810

FLURBIPROFEN 100 MG TABLET

Prescription Drug - Generic

$3

—

64950024304

CARBINOXAMINE 4 MG/5 ML LIQUID

Prescription Drug - Generic

$1

—

64950026810

CLEMASTINE FUM 2.68 MG TABLET

Prescription Drug - Generic

$3

—

64950032412

CLEMASTINE 0.5 MG/5 ML SYRUP

Prescription Drug - Generic

$5

—

My Cost List