Medical Procedure Costs

Surgery - Digestive

$843

—

42205

Surgery - Digestive

$868

—

42210

INDOCIN 25 MG/5 ML SUSPENSION

Surgery - Digestive

$970

—

42211010111

Prescription Drug - Brand

$4

—

42211020429

ZORVOLEX 35 MG CAPSULE

Prescription Drug - Brand

$8

—

42211020523

VIVLODEX 5 MG CAPSULE

Prescription Drug - Brand

$25

—

42211020623

VIVLODEX 10 MG CAPSULE

Prescription Drug - Brand

$25

—

42215

Surgery - Digestive

$649

—

42220

Surgery - Digestive

$539

—

42225

Repair nose to lip fistula

Surgery - Digestive

$969

—

42226

Lengthening of palate

Surgery - Digestive

$835

—

42227

Lengthening of palate

Surgery - Digestive

$775

—

42235

Repair palate

Surgery - Digestive

$690

—

42260

Surgery - Digestive

$587

—

42280

Preparation palate mold

Surgery - Digestive

$98

—

42281

Insertion palate prosthesis

Surgery - Digestive

$154

—

42292000220

DIGITEK 250 MCG TABLET

Prescription Drug - Generic

$0

—

42292000320

DIGITEK 125 MCG TABLET

Prescription Drug - Generic

$0

—

42300

Surgery - Digestive

$142

—

42305

Surgery - Digestive

$385

—

42310

Surgery - Digestive

$128

—

42320

Removal of salivary stone

Surgery - Digestive

$162

—

42330

Surgery - Digestive

$150

—

42335

Removal of salivary stone

Surgery - Digestive

$239

—

42340

Removal of salivary stone

Surgery - Digestive

$309

—

42385093412

LOPINAVIR-RITONAVR 200-50 MG TB

Prescription Drug - Generic

$5

—

42400

Biopsy of salivary gland

Surgery - Digestive

$48

—

42405

Biopsy of salivary gland

Surgery - Digestive

$202

—

42408

Excision of salivary cyst

Surgery - Digestive

$324

—

42409

Drainage of salivary cyst

Surgery - Digestive

$210

—

42410

Surgery - Digestive

$557

—

42415

Surgery - Digestive

$920

—

42420

Surgery - Digestive

$1,026

—

42425

Surgery - Digestive

$730

—

42426