Medical Procedure Costs

13925016750

MULTI-VIT W-FLUOR 0.25 MG/ML

Prescription Drug - Generic

$0

—

13925016850

MULTI-VIT W-FLUOR 0.5 MG/ML

Prescription Drug - Generic

$0

—

13925017050

TRIPLE-VIT W-FLUOR 0.25 MG/ML

Prescription Drug - Generic

$0

—

13925017101

ESTROGEN-METHYLTESTOS H.S. TAB

Prescription Drug - Generic

$3

—

13925017201

ESTROGEN-METHYLTESTOS F.S. TAB

Prescription Drug - Generic

$3

—

13925050910

PRENATAL PLUS TABLET

Prescription Drug - Generic

$0

—

14000

Tis trnfr trunk 10 sq cm/<

Surgery - Integumentary

$465

—

14001

Tis trnfr trunk 10.1-30sqcm

Surgery - Integumentary

$602

—

14020

Tis trnfr s/a/l 10 sq cm/<

Surgery - Integumentary

$505

—

14021

Tis trnfr s/a/l 10.1-30 sqcm

Surgery - Integumentary

$620

—

14040

Tis trnfr f/c/c/m/n/a/g/h/f

Surgery - Integumentary

$546

—

14041

Tis trnfr f/c/c/m/n/a/g/h/f

Surgery - Integumentary

$653

—

14060

Tis trnfr e/n/e/l 10 sq cm/<

Surgery - Integumentary

$573

—

14061

Tis trnfr e/n/e/l10.1-30sqcm

Surgery - Integumentary

$699

—

14301

Tis trnfr any 30.1-60 sq cm

Surgery - Integumentary

$768

—

14302

Tis trnfr addl 30 sq cm

Surgery - Integumentary

$183

—

14350

Filleted finger/toe flap

Surgery - Integumentary

$615

—

15002

Wound prep trk/arm/leg

Surgery - Integumentary

$197

—

15003

Wound prep addl 100 cm

Surgery - Integumentary

$40

—

15004

Wound prep f/n/hf/g

Surgery - Integumentary

$229

—

15005

Wnd prep f/n/hf/g addl cm

Surgery - Integumentary

$78

—

15040

Harvest cultured skin graft

Surgery - Integumentary

$114

—

15050

Pinch graft up to 2 cm diam

Surgery - Integumentary

$429

—

15100

Splt agrft t/a/l 1st 100sqcm

Surgery - Integumentary

$660

—

15101

Splt agrft t/a/l ea addl 100

Surgery - Integumentary

$101

—

15110

Epidrm agrft t/a/l 1st 100

Surgery - Integumentary

$671

—

15111

Epidrm agrft t/a/l ea addl

Surgery - Integumentary

$91

—

15115

Epdrm agrft f/s/n/h/f/g/m 1

Surgery - Integumentary

$651

—

15116

Epdrm agrft f/s/n/h/f/g/m ea

Surgery - Integumentary

$123

—

15120

Splt agrft f/s/n/h/f/g/m 1st

Surgery - Integumentary

$615

—

15121

Splt agrft f/s/n/h/f/g/m ea

Surgery - Integumentary

$119

—

15127001030

SB WOMEN'S GENTLE LAX EC 5 MG

Prescription Drug - Generic

$0

—

15127001824

SB ALLERGY MED 25 MG TABLET

Prescription Drug - Generic

$0

—

15127004217

SB GAS RELIEF 40 MG/0.6 ML DRP

Prescription Drug - Generic

$0

—

15127005024

SB ALLERFED COLD-ALLERGY TAB

Prescription Drug - Generic

$0

—

15127005255

SB POVIDONE-IODINE 10% SOLN

Prescription Drug - Generic

$0

—

15127007208

SB NON-ASPIRIN 325 MG TABLET

Prescription Drug - Generic

$0

—

15127008224

SB SINUS-ALLERGY TABLET

Prescription Drug - Generic

$0

—

15127011501

SB EAR WAX REMOVAL 6.5% DROP

Prescription Drug - Generic

$0

—

15127012201

SB TRIPLE ANTIBIOTIC OINTMENT

Prescription Drug - Generic

$0

—

15127012701

SB HYDROCORTISONE 1% CREAM

Prescription Drug - Generic

$0

—

15127012801

SB HYDROCORTISONE 1% OINTMENT

Prescription Drug - Generic

$0

—

15127012960

SB MUCUS RELIEF 200 MG TABLET

Prescription Drug - Generic

$0

—

15127013812

SB URINARY PAIN RLF 97.5 MG TB

Prescription Drug - Generic

$0

—

15127015150

COUGHTAB 400 MG TABLET

Prescription Drug - Generic

$0

—

15127017050

SB MUCUS RELIEF DM TABLET

Prescription Drug - Generic

$0

—

15127017150

SB MUCUS RELIEF PE CAPLET

Prescription Drug - Generic

$0

—

15127017807

SB BISACODYL EC 5 MG TABLET

Prescription Drug - Generic

$0

—

15127018008

SB BISMUTH CHEWABLE TABLET

Prescription Drug - Generic

$0

—

15127018424

SB COLD-FLU SEVERE CAPLET

Prescription Drug - Generic

$0

—

My Cost List