Medical Procedure Costs

Surgery - Musculoskeletal

$132

—

28495

Surgery - Musculoskeletal

$154

—

28496

Surgery - Musculoskeletal

$281

—

28505

Treatment of toe fracture

Surgery - Musculoskeletal

$471

—

28510

Surgery - Musculoskeletal

$125

—

28515

Treatment of toe fracture

Surgery - Musculoskeletal

$145

—

28525

Treat toe fracture

Surgery - Musculoskeletal

$386

—

28530

Treat sesamoid bone fracture

Surgery - Musculoskeletal

$103

—

28531

Treat sesamoid bone fracture

Surgery - Musculoskeletal

$175

—

28540

Surgery - Musculoskeletal

$171

—

28545

Surgery - Musculoskeletal

$277

—

28546

Surgery - Musculoskeletal

$358

—

28555

Repair foot dislocation

Surgery - Musculoskeletal

$612

—

28570

Surgery - Musculoskeletal

$205

—

28575

Surgery - Musculoskeletal

$342

—

28576

AUGMENTIN 125-31.25 MG/5 ML

Surgery - Musculoskeletal

$386

—

28585

Repair foot dislocation

Surgery - Musculoskeletal

$676

—

28595024035

Prescription Drug - Brand

$6

—

28595080016

AP-HIST DM LIQUID

Prescription Drug - Generic

$0

—

28595080130

HISTEX PD 0.938 MG/ML DROPS

Prescription Drug - Generic

$2

—

28595080208

HISTEX 2.5 MG/5 ML SYRUP

Prescription Drug - Generic

$0

—

28595080416

HISTEX-DM SYRUP

Prescription Drug - Generic

$0

—

28595090060

RU-HIST D 10-4 MG TABLET

Prescription Drug - Generic

$1

—

28600

Surgery - Musculoskeletal

$158

—

28605

Surgery - Musculoskeletal

$312

—

28606

Surgery - Musculoskeletal

$387

—

28615

Repair foot dislocation

Surgery - Musculoskeletal

$793

—

28630

Surgery - Musculoskeletal

$111

—

28635

Surgery - Musculoskeletal

$123

—

28636

Surgery - Musculoskeletal

$217

—

28645

Repair toe dislocation

Surgery - Musculoskeletal

$461

—

28660

Surgery - Musculoskeletal

$101

—

28665

Surgery - Musculoskeletal

$120

—

28666