Medical Procedure Costs

24546

Optx hum fx w/ntrcndylr xtn

Surgery - Musculoskeletal

$954

—

24560

Cltx hum epcndylr fx wo mnpj

Surgery - Musculoskeletal

$320

—

24565

Cltx hum epcndylr fx w/mnpj

Surgery - Musculoskeletal

$487

—

24566

Prq skel fix epcndylr hum fx

Surgery - Musculoskeletal

$691

—

24575

Optx humeral epcndylr fx

Surgery - Musculoskeletal

$695

—

24576

Cltx humrl cndylr fx wo mnpj

Surgery - Musculoskeletal

$338

—

24577

Cltx humrl cndylr fx w/mnpj

Surgery - Musculoskeletal

$498

—

24579

Optx humrl cndylr fracture

Surgery - Musculoskeletal

$780

—

24582

Prq skel fix humrl cndylr fx

Surgery - Musculoskeletal

$783

—

24586

Optx partclr fx&/dislc elbow

Surgery - Musculoskeletal

$989

—

24587

Optx partclr fx&/dslc elbw w

Surgery - Musculoskeletal

$999

—

24600

Tx clsd elbow dislc w/o anes

Surgery - Musculoskeletal

$402

—

24605

Tx clsd elbow dislc req anes

Surgery - Musculoskeletal

$479

—

24615

Optx aqt/chrnc elbow dislc

Surgery - Musculoskeletal

$665

—

24620

Cltx monteggia fx dislc elbw

Surgery - Musculoskeletal

$568

—

24635

Optx monteggia fx dislc elbw

Surgery - Musculoskeletal

$640

—

24640

Cltx rdl head sublxtj nrsemd

Surgery - Musculoskeletal

$71

—

24650

Cltx rdl head/nck fx wo mnpj

Surgery - Musculoskeletal

$259

—

24655

Cltx rdl head/nck fx w/mnpj

Surgery - Musculoskeletal

$442

—

24658017190

DILTIAZEM HCL ER 180 MG CAP

Prescription Drug - Generic

$0

—

24658017390

DILTIAZEM HCL ER 300 MG CAP

Prescription Drug - Generic

$1

—

24665

Optx radial head/neck fx

Surgery - Musculoskeletal

$622

—

24666

Optx radial head/nck fx rplc

Surgery - Musculoskeletal

$685

—

24670

Cltx ulnar fx prox w/o mnpj

Surgery - Musculoskeletal

$282

—

24675

Cltx ulnar fx prox w/mnpj

Surgery - Musculoskeletal

$424

—

24685

Optx ulnar fx prox end w/fix

Surgery - Musculoskeletal

$622

—

24689010201

HYDROCORTISONE AC 25 MG SUPP

Prescription Drug - Generic

$1

—

24689012302

GUAIFENESIN-DM 400-20 MG TAB

Prescription Drug - Generic

$0

—

24689014401

GUAIFENESIN 400 MG TABLET

Prescription Drug - Generic

$0

—

24800

Arthrodesis elbw joint local

Surgery - Musculoskeletal

$781

—

24802

Arthrd elbow jt autog graft

Surgery - Musculoskeletal

$927

—

24900

Amputation of upper arm

Surgery - Musculoskeletal

$720

—

24920

Amputation of upper arm

Surgery - Musculoskeletal

$687

—

24925

Amputation follow-up surgery

Surgery - Musculoskeletal

$545

—

24930

Amputation follow-up surgery

Surgery - Musculoskeletal

$722

—

24931

Amputate upper arm & implant

Surgery - Musculoskeletal

$858

—

24935

Revision of amputation

Surgery - Musculoskeletal

$1,137

—

24979003504

CYCLOBENZAPRINE ER 15 MG CAP

Prescription Drug - Generic

$1

—

24979003604

CYCLOBENZAPRINE ER 30 MG CAP

Prescription Drug - Generic

$1

—

24979004113

MEGESTROL 625 MG/5 ML SUSP

Prescription Drug - Generic

$1

—

24979024806

BUPROPION HCL XL 450 MG TABLET

Prescription Drug - Generic

$8

—

24987008730

DUTOPROL 25-12.5 MG TABLET

Prescription Drug - Brand

$5

—

24987009530

DUTOPROL 50-12.5 MG TABLET

Prescription Drug - Brand

$5

—

24987024255

LANOXIN 125 MCG TABLET

Prescription Drug - Brand

$11

—

24987024975

LANOXIN 250 MCG TABLET

Prescription Drug - Brand

$12

—

25000

Incision of tendon sheath

Surgery - Musculoskeletal

$340

—

25001

Incise flexor carpi radialis

Surgery - Musculoskeletal

$341

—

25010021515

EDECRIN 25 MG TABLET

Prescription Drug - Brand

$22

—

25010070515

CUPRIMINE 250 MG CAPSULE

Prescription Drug - Brand

$256

—

25010071115

LODOSYN 25 MG TABLET

Prescription Drug - Brand

$26

—

My Cost List