Medical Procedure Costs

10007

Fna bx w/fluor gdn 1st les

Surgery - Integumentary

$80

—

10008

Fna bx w/fluor gdn ea addl

Surgery - Integumentary

$47

—

10009

Fna bx w/ct gdn 1st les

Surgery - Integumentary

$93

—

10010

Fna bx w/ct gdn ea addl

Surgery - Integumentary

$66

—

10019003867

FENTANYL 0.05 MG/ML AMPUL

Prescription Drug - Generic

$1

—

10019055303

TRANSDERM-SCOP 1.5 MG/3 DAY

Prescription Drug - Brand

$20

—

10019055304

TRANSDERM-SCOP 1 MG/3 DAY PTCH

Prescription Drug - Brand

$20

—

10019055388

TRANSDERM-SCOP 1.5 MG/72HR

Prescription Drug - Brand

$19

—

10021

Fna bx w/o img gdn 1st les

Surgery - Integumentary

$46

—

10030

Img gid flu coll drg sft tis

Surgery - Integumentary

$118

—

10035

Plmt sft tiss loclzj dev 1st

Surgery - Integumentary

$71

—

10036

Plmt sft tiss loclzj dev ea

Surgery - Integumentary

$37

—

10040

Extraction

Surgery - Integumentary

$42

—

10060

I&d abscess simple/single

Surgery - Integumentary

$101

—

10061

I&d abscess comp/multiple

Surgery - Integumentary

$173

—

10080

I&d pilonidal cyst simple

Surgery - Integumentary

$105

—

10081

I&d pilonidal cyst comp

Surgery - Integumentary

$169

—

10094020560

SYMPAZAN 5 MG FILM

Prescription Drug - Brand

$16

—

10094021060

SYMPAZAN 10 MG FILM

Prescription Drug - Brand

$33

—

10094022060

SYMPAZAN 20 MG FILM

Prescription Drug - Brand

$65

—

10120

Inc&rmvl fb subq tiss smpl

Surgery - Integumentary

$102

—

10121

Inc&rmvl fb subq tiss comp

Surgery - Integumentary

$172

—

10122090212

ZYFLO CR 600 MG TABLET

Prescription Drug - Brand

$30

—

10139006240

METHOTREXATE 1 GM/40 ML VIAL

Prescription Drug - Generic

$1

—

10140

I&d hmtma seroma/fluid collj

Surgery - Integumentary

$116

—

10160

Pnxr aspir absc hmtma bulla

Surgery - Integumentary

$92

—

10180

I&d complex po wound infctj

Surgery - Integumentary

$176

—

10267146501

POLYSACCHARIDE IRON CAPSULE

Prescription Drug - Generic

$0

—

10267210301

POLYSACCHARIDE IRON FORTE

Prescription Drug - Generic

$0

—

10337035830

OXISTAT 1% CREAM

Prescription Drug - Brand

$21

—

10337039530

APEXICON E 0.05% CREAM

Prescription Drug - Brand

$19

—

10337080301

SOLARAZE 3% GEL

Prescription Drug - Brand

$16

—

10337080445

ZONALON 5% CREAM

Prescription Drug - Brand

$9

—

10337090510

KERYDIN 5% TOPICAL SOLUTION

Prescription Drug - Brand

$145

—

10542000909

DIALYVITE SUPREME D TABLET

Prescription Drug - Generic

$0

—

10542001010

DIALYVITE TABLET

Prescription Drug - Generic

$0

—

10542001210

DIALYVITE WITH ZINC TABLET

Prescription Drug - Generic

$0

—

10542001409

DIALYVITE 3,000 TABLET

Prescription Drug - Generic

$0

—

10572030201

PEG-3350 SOLUTION

Prescription Drug - Generic

$0

—

10572040001

PEG-3350 WITH FLAVOR PACKS SOL

Prescription Drug - Generic

$0

—

10631000331

ABSORICA LD 16 MG CAPSULE

Prescription Drug - Brand

$38

—

10631000531

ABSORICA LD 24 MG CAPSULE

Prescription Drug - Brand

$42

—

10631000731

ABSORICA LD 32 MG CAPSULE

Prescription Drug - Brand

$42

—

10631000830

KAPSPARGO SPRINKLE 25 MG CAP

Prescription Drug - Brand

$2

—

10631000930

KAPSPARGO SPRINKLE 50 MG CAP

Prescription Drug - Brand

$2

—

10631001030

KAPSPARGO SPRINKLE 100 MG CAP

Prescription Drug - Brand

$2

—

10631009160

EURAX 10% CREAM

Prescription Drug - Brand

$8

—

10631009307

KENALOG 0.147 MG/GRAM SPRAY

Prescription Drug - Brand

$8

—

10631009420

HALOG 0.1% CREAM

Prescription Drug - Brand

$14

—

10631009630

HALOG 0.1% OINTMENT

Prescription Drug - Brand

$12

—

My Cost List