Medical Procedure Costs

69618001203

ACETAMINOPHEN 80 MG TAB CHEW

Prescription Drug - Generic

$0

—

69618002110

CALCIUM CARBONATE 10 GRAIN TAB

Prescription Drug - Generic

$0

—

69618002210

CHLORPHENIRAMINE 4 MG TABLET

Prescription Drug - Generic

$0

—

69618002501

DIPHENHYDRAMINE 25 MG CAPLET

Prescription Drug - Generic

$0

—

69618003006

CALCIUM POLYCARBOPHIL 625 MG

Prescription Drug - Generic

$0

—

69620

Myringoplasty

Surgery - Auditory

$452

—

69631

Repair eardrum structures

Surgery - Auditory

$799

—

69632

Rebuild eardrum structures

Surgery - Auditory

$969

—

69633

Rebuild eardrum structures

Surgery - Auditory

$943

—

69635

Repair eardrum structures

Surgery - Auditory

$1,176

—

69636

Rebuild eardrum structures

Surgery - Auditory

$1,289

—

69637

Rebuild eardrum structures

Surgery - Auditory

$1,285

—

69641

Revise middle ear & mastoid

Surgery - Auditory

$928

—

69642

Revise middle ear & mastoid

Surgery - Auditory

$1,185

—

69643

Revise middle ear & mastoid

Surgery - Auditory

$1,088

—

69644

Revise middle ear & mastoid

Surgery - Auditory

$1,371

—

69645

Revise middle ear & mastoid

Surgery - Auditory

$1,351

—

69646

Revise middle ear & mastoid

Surgery - Auditory

$1,431

—

69650

Stapes mobilization

Surgery - Auditory

$717

—

69654050105

PRIMSOL 50 MG/5 ML ORAL SOLN

Prescription Drug - Brand

$2

—

69660

Revise middle ear bone

Surgery - Auditory

$819

—

69661

Revise middle ear bone

Surgery - Auditory

$1,064

—

69662

Revise middle ear bone

Surgery - Auditory

$1,020

—

69666

Repair middle ear structures

Surgery - Auditory

$721

—

69667

Repair middle ear structures

Surgery - Auditory

$724

—

69670

Remove mastoid air cells

Surgery - Auditory

$840

—

69676

Remove middle ear nerve

Surgery - Auditory

$747

—

69680011399

CYANOCOBALAMIN 10,000 MCG/10

Prescription Drug - Generic

$1

—

69680013060

PROPAFENONE HCL ER 225 MG CAP

Prescription Drug - Generic

$0

—

69680013160

PROPAFENONE HCL ER 325 MG CAP

Prescription Drug - Generic

$0

—

69680014530

PRAMIPEXOLE ER 0.375 MG TABLET

Prescription Drug - Generic

$1

—

69680014630

PRAMIPEXOLE ER 0.75 MG TABLET

Prescription Drug - Generic

$1

—

69680016500

THYROID 15 MG TABLET

Prescription Drug - Generic

$1

—

69680016600

THYROID 30 MG TABLET

Prescription Drug - Generic

$1

—

69680016700

THYROID 60 MG TABLET

Prescription Drug - Generic

$1

—

69680016800

THYROID 90 MG TABLET

Prescription Drug - Generic

$1

—

69680016900

THYROID 120 MG TABLET

Prescription Drug - Generic

$1

—

69680018330

MEMANTINE-DONEPEZIL ER 14-10 MG

Prescription Drug - Generic

$12

—

69680018530

MEMANTINE-DONEPEZIL ER 28-10 MG

Prescription Drug - Generic

$14

—

69700

Close mastoid fistula

Surgery - Auditory

$598

—

69705

Nps surg dilat eust tube uni

Surgery - Auditory

$148

—

69706

Nps surg dilat eust tube bi

Surgery - Auditory

$205

—

69711

Remove/repair hearing aid

Surgery - Auditory

$750

—

69714

Impl oi implt skull perq esp

Surgery - Auditory

$438

—

69716

Impl oi implt sk tc esp<100

Surgery - Auditory

$544

—

69717

Rplcmt oi implt skl prq esp

Surgery - Auditory

$493

—

69719

Rplcm oi implt sk tc esp<100

Surgery - Auditory

$562

—

69720

Release facial nerve

Surgery - Auditory

$1,060

—

69725

Release facial nerve

Surgery - Auditory

$1,626

—

69726

Rmv ntr oi implt skl prq esp

Surgery - Auditory

$423

—

My Cost List