Medical Procedure Costs

24385063423

LICE SOLUTION KIT

Prescription Drug - Generic

$11

—

24385067510

CITRATE OF MAGNESIA SOLN

Prescription Drug - Generic

$0

—

24385078530

GAS RELIEF DROPS

Prescription Drug - Generic

$0

—

24385090378

BISA-LAX EC 5 MG TABLET

Prescription Drug - Generic

$0

—

24385090426

TUSSIN CF COUGH-COLD SYRUP

Prescription Drug - Generic

$0

—

24385090434

TUSSIN CF COUGH & COLD SYRUP

Prescription Drug - Generic

$0

—

24385092462

COLD & ALLERGY PE TABLET

Prescription Drug - Generic

$0

—

24385092571

CHEST-SINUS CONGST RLF TABLET

Prescription Drug - Generic

$0

—

24385096162

SINUS-ALLERGY PE TABLET

Prescription Drug - Generic

$0

—

24385096360

COLD RELIEF HEAD CONGEST CPLT

Prescription Drug - Generic

$0

—

24385098526

GNP CHILD MUCUS RLF COUGH LIQ

Prescription Drug - Generic

$0

—

24400

Osteot humerus w/wo int fixj

Surgery - Musculoskeletal

$775

—

24410

Mlt osteot rlgnm imed rd hum

Surgery - Musculoskeletal

$977

—

24420

Osteoplasty humerus

Surgery - Musculoskeletal

$1,002

—

24430

Rpr non/mal humerus wo graft

Surgery - Musculoskeletal

$970

—

24435

Rpr non/mal hum with agrft

Surgery - Musculoskeletal

$1,004

—

24470

Hemiepiphyseal arrest

Surgery - Musculoskeletal

$639

—

24478007401

QUILLICHEW ER 20 MG CHEW TAB

Prescription Drug - Brand

$12

—

24478007501

QUILLICHEW ER 30 MG CHEW TAB

Prescription Drug - Brand

$12

—

24478007601

QUILLICHEW ER 40 MG CHEW TAB

Prescription Drug - Brand

$12

—

24478010201

DYANAVEL XR 2.5 MG/ML SUSP

Prescription Drug - Brand

$3

—

24478010601

DYANAVEL XR 5 MG TABLET

Prescription Drug - Brand

$8

—

24478010801

DYANAVEL XR 10 MG TABLET

Prescription Drug - Brand

$15

—

24478010901

DYANAVEL XR 15 MG TABLET

Prescription Drug - Brand

$15

—

24478011001

DYANAVEL XR 20 MG TABLET

Prescription Drug - Brand

$15

—

24478014803

ONYDA XR 0.1 MG/ML SUSPENSION

Prescription Drug - Brand

$13

—

24478032406

QUILLIVANT XR 25 MG/5 ML SUSP

Prescription Drug - Brand

$2

—

24495

Decompression fasct forearm

Surgery - Musculoskeletal

$907

—

24498

Proph tx w/wo mthylmthcrylt

Surgery - Musculoskeletal

$802

—

24500

Cltx humrl shft fx w/o mnpj

Surgery - Musculoskeletal

$349

—

24505

Cltx humrl shft fx w/mnpj

Surgery - Musculoskeletal

$474

—

24510005010

NUCYNTA 50 MG TABLET

Prescription Drug - Brand

$10

—

24510005860

NUCYNTA ER 50 MG TABLET

Prescription Drug - Brand

$11

—

24510007510

NUCYNTA 75 MG TABLET

Prescription Drug - Brand

$12

—

24510010010

NUCYNTA 100 MG TABLET

Prescription Drug - Brand

$16

—

24510011010

XTAMPZA ER 9 MG CAPSULE

Prescription Drug - Brand

$6

—

24510011510

XTAMPZA ER 13.5 MG CAPSULE

Prescription Drug - Brand

$9

—

24510011660

NUCYNTA ER 100 MG TABLET

Prescription Drug - Brand

$20

—

24510012010

XTAMPZA ER 18 MG CAPSULE

Prescription Drug - Brand

$11

—

24510013010

XTAMPZA ER 27 MG CAPSULE

Prescription Drug - Brand

$16

—

24510014010

XTAMPZA ER 36 MG CAPSULE

Prescription Drug - Brand

$20

—

24510017460

NUCYNTA ER 150 MG TABLET

Prescription Drug - Brand

$25

—

24510023260

NUCYNTA ER 200 MG TABLET

Prescription Drug - Brand

$32

—

24510029160

NUCYNTA ER 250 MG TABLET

Prescription Drug - Brand

$40

—

24515

Optx humrl shft fx plate/scr

Surgery - Musculoskeletal

$822

—

24516

Tx humrl shaft fx imed implt

Surgery - Musculoskeletal

$798

—

24530

Cltx sprcndylr humeral fx wo

Surgery - Musculoskeletal

$359

—

24535

Cltx sprcndylr humeral fx w/

Surgery - Musculoskeletal

$565

—

24538

Prq skel fix sprcndlr hum fx

Surgery - Musculoskeletal

$752

—

24545

Optx hum fx wo ntrcndylr xtn

Surgery - Musculoskeletal

$860

—

My Cost List