Medical Procedure Costs

12031

Intmd rpr s/a/t/ext 2.5 cm/<

Surgery - Integumentary

$133

—

12032

Intmd rpr s/a/t/ext 2.6-7.5

Surgery - Integumentary

$165

—

12034

Intmd rpr s/tr/ext 7.6-12.5

Surgery - Integumentary

$180

—

12035

Intmd rpr s/a/t/ext 12.6-20

Surgery - Integumentary

$224

—

12036

Intmd rpr s/a/t/ext 20.1-30

Surgery - Integumentary

$270

—

12037

Intmd rpr s/tr/ext >30.0 cm

Surgery - Integumentary

$308

—

12041

Intmd rpr n-hf/genit 2.5cm/<

Surgery - Integumentary

$129

—

12042

Intmd rpr n-hf/genit2.6-7.5

Surgery - Integumentary

$168

—

12044

Intmd rpr n-hf/genit7.6-12.5

Surgery - Integumentary

$191

—

12045

Intmd rpr n-hf/genit12.6-20

Surgery - Integumentary

$269

—

12046

Intmd rpr n-hf/genit20.1-30

Surgery - Integumentary

$313

—

12047

Intmd rpr n-hf/genit >30.0cm

Surgery - Integumentary

$346

—

12051

Intmd rpr face/mm 2.5 cm/<

Surgery - Integumentary

$149

—

12052

Intmd rpr face/mm 2.6-5.0 cm

Surgery - Integumentary

$173

—

12053

Intmd rpr face/mm 5.1-7.5 cm

Surgery - Integumentary

$187

—

12054

Intmd rpr face/mm 7.6-12.5cm

Surgery - Integumentary

$197

—

12055

Intmd rpr face/mm 12.6-20 cm

Surgery - Integumentary

$294

—

12056

Intmd rpr face/mm 20.1-30.0

Surgery - Integumentary

$349

—

12057

Intmd rpr face/mm >30.0 cm

Surgery - Integumentary

$382

—

12496000302

OPVEE 2.7 MG NASAL SPRAY

Prescription Drug - Brand

$47

—

12496009001

PERSERIS ER 90 MG SYRINGE KIT

Prescription Drug - Brand

$2,072

—

12496009002

PERSERIS ER 90 MG POWDER SYRNG

Prescription Drug - Brand

$2,072

—

12496012001

PERSERIS ER 120 MG SYRINGE KIT

Prescription Drug - Brand

$2,766

—

12496120203

SUBOXONE 2 MG-0.5 MG SL FILM

Prescription Drug - Brand

$5

—

12496120403

SUBOXONE 4 MG-1 MG SL FILM

Prescription Drug - Brand

$9

—

12496120803

SUBOXONE 8 MG-2 MG SL FILM

Prescription Drug - Brand

$9

—

12496121203

SUBOXONE 12 MG-3 MG SL FILM

Prescription Drug - Brand

$17

—

12830071716

M-CLEAR WC LIQUID

Prescription Drug - Generic

$0

—

12830073516

M-END WC LIQUID

Prescription Drug - Generic

$0

—

12830075412

M-END PE LIQUID

Prescription Drug - Generic

$0

—

12830076216

CHLO TUSS LIQUID

Prescription Drug - Generic

$0

—

12830081016

M-END DM SYRUP

Prescription Drug - Generic

$0

—

12830081101

FERUS 150 MG CAPSULE

Prescription Drug - Generic

$0

—

12830081616

M-END DMX LIQUID

Prescription Drug - Generic

$0

—

12830082430

EZFE 200 CAPSULE

Prescription Drug - Generic

$0

—

12830086416

CHLO HIST ORAL SOLUTION

Prescription Drug - Generic

$0

—

13100

Cmplx rpr trunk 1.1-2.5 cm

Surgery - Integumentary

$171

—

13101

Cmplx rpr trunk 2.6-7.5 cm

Surgery - Integumentary

$210

—

13102

Cmplx rpr trunk addl 5cm/<

Surgery - Integumentary

$60

—

13107004501

OXYCODON-ACETAMINOPHEN 7.5-325

Prescription Drug - Generic

$1

—

13120

Cmplx rpr s/a/l 1.1-2.5 cm

Surgery - Integumentary

$198

—

13121

Cmplx rpr s/a/l 2.6-7.5 cm

Surgery - Integumentary

$215

—

13122

Cmplx rpr s/a/l addl 5 cm/>

Surgery - Integumentary

$68

—

13131

Cmplx rpr f/c/c/m/n/ax/g/h/f

Surgery - Integumentary

$204

—

13132

Cmplx rpr f/c/c/m/n/ax/g/h/f

Surgery - Integumentary

$251

—

13133

Cmplx rpr f/c/c/m/n/ax/g/h/f

Surgery - Integumentary

$102

—

13151

Cmplx rpr e/n/e/l 1.1-2.5 cm

Surgery - Integumentary

$233

—

13152

Cmplx rpr e/n/e/l 2.6-7.5 cm

Surgery - Integumentary

$279

—

13153

Cmplx rpr e/n/e/l addl 5cm/<

Surgery - Integumentary

$114

—

13160

Sec clsr surg wnd/dehsn xtn

Surgery - Integumentary

$741

—

My Cost List