Medical Procedure Costs

41512

Tongue suspension

Surgery - Digestive

$619

—

41520

Reconstruction tongue fold

Surgery - Digestive

$230

—

41530

Tongue base vol reduction

Surgery - Digestive

$362

—

41800

Drainage of gum lesion

Surgery - Digestive

$189

—

41805

Removal foreign body gum

Surgery - Digestive

$192

—

41806

Removal foreign body jawbone

Surgery - Digestive

$263

—

41822

Excision of gum lesion

Surgery - Digestive

$188

—

41823

Excision of gum lesion

Surgery - Digestive

$357

—

41825

Excision of gum lesion

Surgery - Digestive

$111

—

41826

Excision of gum lesion

Surgery - Digestive

$179

—

41827

Excision of gum lesion

Surgery - Digestive

$264

—

41828

Excision of gum lesion

Surgery - Digestive

$200

—

41830

Removal of gum tissue

Surgery - Digestive

$295

—

41872

Gingivoplasty each quadrant

Surgery - Digestive

$299

—

41874

Alveoloplasty each quadrant

Surgery - Digestive

$225

—

42000

Drainage mouth roof lesion

Surgery - Digestive

$99

—

42023010110

ADRENALIN CL 1 MG/ML VIAL

Prescription Drug - Generic

$0

—

42023010401

APLISOL 5T UNITS/0.1 ML VIAL

Prescription Drug - Brand

$84

—

42023010405

APLISOL 5T UNIT/0.1 ML VIAL

Prescription Drug - Brand

$93

—

42023010801

COLY-MYCIN S EAR DROPS

Prescription Drug - Brand

$7

—

42023010901

CORTISPORIN-TC EAR SUSP

Prescription Drug - Brand

$16

—

42023011001

DELESTROGEN 50 MG/5 ML VIAL

Prescription Drug - Brand

$25

—

42023011101

DELESTROGEN 20 MG/ML VIAL

Prescription Drug - Brand

$29

—

42023011201

DELESTROGEN 200 MG/5 ML VIAL

Prescription Drug - Brand

$60

—

42023015925

ADRENALIN 1 MG/ML VIAL

Prescription Drug - Brand

$8

—

42100

Biopsy roof of mouth

Surgery - Digestive

$102

—

42104

Excision lesion mouth roof

Surgery - Digestive

$123

—

42106

Excision lesion mouth roof

Surgery - Digestive

$150

—

42107

Excision lesion mouth roof

Surgery - Digestive

$305

—

42120

Remove palate/lesion

Surgery - Digestive

$912

—

42140

Excision of uvula

Surgery - Digestive

$152

—

42145

Repair palate pharynx/uvula

Surgery - Digestive

$609

—

42160

Treatment mouth roof lesion

Surgery - Digestive

$129

—

42180

Repair lac palate<2 cm

Surgery - Digestive

$169

—

42182

Repair palate

Surgery - Digestive

$228

—

42192011003

BPO 4% CREAMY WASH PACK

Prescription Drug - Generic

$54

—

42192012116

SULFACETAMIDE-SULFUR 9-4% WASH

Prescription Drug - Generic

$0

—

42192013440

SALICYLIC ACID 6% GEL

Prescription Drug - Generic

$6

—

42192013510

SALICYLIC ACID 27.5% LIQUID

Prescription Drug - Generic

$5

—

42192013901

SSS 10-5 CREAM

Prescription Drug - Generic

$2

—

42192030160

BP VIT 3 CAPSULE

Prescription Drug - Generic

$1

—

42192032090

PNV-SELECT TABLET

Prescription Drug - Generic

$1

—

42192032130

PNV-DHA SOFTGEL

Prescription Drug - Generic

$1

—

42192032730

NP THYROID 15 MG TABLET

Prescription Drug - Generic

$1

—

42192032830

NP THYROID 120 MG TABLET

Prescription Drug - Generic

$1

—

42192032930

NP THYROID 30 MG TABLET

Prescription Drug - Generic

$1

—

42192033030

NP THYROID 60 MG TABLET

Prescription Drug - Generic

$1

—

42192033130

NP THYROID 90 MG TABLET

Prescription Drug - Generic

$1

—

42192062328

LEVONORGESTREL-ETH ESTRADIOL-FE BISGLYC 0.1-0.02-36.5 MG TAB

Prescription Drug - Generic

$5

—

42195010090

FENOPROFEN 400 MG CAPSULE

Prescription Drug - Generic

$3

—

My Cost List