Medical Procedure Costs

42650

Dilation of salivary duct

Surgery - Digestive

$53

—

42660

Dilation of salivary duct

Surgery - Digestive

$70

—

42665

Ligation of salivary duct

Surgery - Digestive

$197

—

42667551101

NATESTO NASAL 5.5 MG/0.122 GM

Prescription Drug - Brand

$41

—

42700

I&d abscess peritonsillar

Surgery - Digestive

$128

—

42720

I&d absc phrngl ntraorl appr

Surgery - Digestive

$334

—

42725

I&d absc phrngl xtrnl appr

Surgery - Digestive

$708

—

42747032730

FARESTON 60 MG TABLET

Prescription Drug - Brand

$41

—

42769138007

HYDROCORTISONE 100 MG ENEMA

Prescription Drug - Generic

$0

—

42799010501

METHENAMINE MD 500 MG TABLET

Prescription Drug - Generic

$1

—

42799010601

METHENAMINE MD 1 GM TABLET

Prescription Drug - Generic

$2

—

42799081201

PREDNISOLONE 10 MG/5 ML SOLN

Prescription Drug - Generic

$2

—

42799081301

PREDNISOLONE 20 MG/5 ML SOLN

Prescription Drug - Generic

$2

—

42800

Biopsy of throat

Surgery - Digestive

$106

—

42804

Biopsy of upper nose/throat

Surgery - Digestive

$113

—

42806

Biopsy of upper nose/throat

Surgery - Digestive

$129

—

42806003712

EPIFLUR 0.25 MG TABLET CHEW

Prescription Drug - Generic

$0

—

42806003801

BETAXOLOL 10 MG TABLET

Prescription Drug - Generic

$1

—

42806003901

BETAXOLOL 20 MG TABLET

Prescription Drug - Generic

$1

—

42806005801

FLAVOXATE HCL 100 MG TABLET

Prescription Drug - Generic

$1

—

42806006012

EPIFLUR 0.5 MG TABLET CHEWABLE

Prescription Drug - Generic

$0

—

42806007312

EPIFLUR 1 MG TABLET CHEWABLE

Prescription Drug - Generic

$0

—

42806009630

PROTRIPTYLINE HCL 5 MG TABLET

Prescription Drug - Generic

$3

—

42806009730

PROTRIPTYLINE HCL 10 MG TABLET

Prescription Drug - Generic

$3

—

42806009830

EPIKLOR 20 MEQ PACKET

Prescription Drug - Generic

$1

—

42806018660

KLAYESTA 100,000 UNIT/GM POWD

Prescription Drug - Generic

$0

—

42806029960

NIZATIDINE 150 MG CAPSULE

Prescription Drug - Generic

$1

—

42808

Excise pharynx lesion

Surgery - Digestive

$148

—

42809

Remove pharynx foreign body

Surgery - Digestive

$117

—

42810

Excision of neck cyst

Surgery - Digestive

$258

—

42815

Excision of neck cyst

Surgery - Digestive

$478

—

42820

Remove tonsils and adenoids

Surgery - Digestive

$261

—

42821

Remove tonsils and adenoids

Surgery - Digestive

$272

—

42825

Removal of tonsils

Surgery - Digestive

$243

—

42826

Removal of tonsils

Surgery - Digestive

$231

—

42830

Removal of adenoids

Surgery - Digestive

$195

—

42831

Removal of adenoids

Surgery - Digestive

$213

—

42835

Removal of adenoids

Surgery - Digestive

$183

—

42836

Removal of adenoids

Surgery - Digestive

$223

—

42842

Extensive surgery of throat

Surgery - Digestive

$911

—

42844

Extensive surgery of throat

Surgery - Digestive

$1,228

—

42845

Extensive surgery of throat

Surgery - Digestive

$1,930

—

42847010330

SILENOR 3 MG TABLET

Prescription Drug - Brand

$17

—

42847010630

SILENOR 6 MG TABLET

Prescription Drug - Brand

$17

—

42847085009

TREXIMET 85-500 MG TABLET

Prescription Drug - Brand

$134

—

42858007545

METHYLPHENIDATE ER 10 MG CAP

Prescription Drug - Generic

$4

—

42858007645

METHYLPHENIDATE ER 15 MG CAP

Prescription Drug - Generic

$3

—

42858007845

METHYLPHENIDATE ER 30 MG CAP

Prescription Drug - Generic

$3

—

42858007945

METHYLPHENIDATE ER 40 MG CAP

Prescription Drug - Generic

$4

—

42858008045

METHYLPHENIDATE ER 50 MG CAP

Prescription Drug - Generic

$4

—

My Cost List