Medical Procedure Costs

43327

Esoph fundoplasty lap

Surgery - Digestive

$791

—

43328

Esoph fundoplasty thor

Surgery - Digestive

$1,061

—

43330

Esophagomyotomy abdominal

Surgery - Digestive

$1,252

—

43331

Esophagomyotomy thoracic

Surgery - Digestive

$1,282

—

43332

Transab esoph hiat hern rpr

Surgery - Digestive

$1,078

—

43333

Transab esoph hiat hern rpr

Surgery - Digestive

$1,176

—

43334

Transthor diaphrag hern rpr

Surgery - Digestive

$1,167

—

43335

Transthor diaphrag hern rpr

Surgery - Digestive

$1,253

—

43336

Thorabd diaphr hern repair

Surgery - Digestive

$1,364

—

43337

Thorabd diaphr hern repair

Surgery - Digestive

$1,451

—

43338

Esoph lengthening

Surgery - Digestive

$104

—

43340

Fuse esophagus & intestine

Surgery - Digestive

$1,292

—

43341

Fuse esophagus & intestine

Surgery - Digestive

$1,338

—

43351

Surgical opening esophagus

Surgery - Digestive

$1,276

—

43352

Surgical opening esophagus

Surgery - Digestive

$1,034

—

43360

Gastrointestinal repair

Surgery - Digestive

$2,122

—

43361

Gastrointestinal repair

Surgery - Digestive

$2,508

—

43386005019

GAVILYTE-N SOLUTION

Prescription Drug - Generic

$0

—

43386006019

GAVILYTE-C SOLUTION

Prescription Drug - Generic

$0

—

43386009019

GAVILYTE-G SOLUTION

Prescription Drug - Generic

$0

—

43386016901

POTASSIUM CL 20% (40 MEQ/15 ML) LIQUID

Prescription Drug - Generic

$1

—

43386028001

DIAZEPAM 10 MG RECTAL GEL (2PK)

Prescription Drug - Generic

$189

—

43386028003

DIAZEPAM 10 MG RECTAL GEL SYRG

Prescription Drug - Generic

$189

—

43386028101

DIAZEPAM 20 MG RECTAL GEL (2PK)

Prescription Drug - Generic

$175

—

43386028103

DIAZEPAM 20 MG RECTAL GEL SYRG

Prescription Drug - Generic

$175

—

43386031214

GAVILAX POWDER

Prescription Drug - Generic

$0

—

43386035003

HYDROCODONE-HOMATROPINE TABLET

Prescription Drug - Generic

$1

—

43386037132

MERZEE 1 MG-20 MCG CAPSULE

Prescription Drug - Generic

$1

—

43386048026

ORPHENADRINE ER 100 MG TABLET

Prescription Drug - Generic

$0

—

43386067001

PENTAZOCIN-ACETAMINOPHN 25-650

Prescription Drug - Generic

$1

—

43386068001

PENTAZOCINE-NALOXONE TABLET

Prescription Drug - Generic

$2

—

43400

Ligate esophagus veins

Surgery - Digestive

$1,420

—

43405

Ligate/staple esophagus

Surgery - Digestive

$1,402

—

43410

Repair esophagus wound

Surgery - Digestive

$902

—

43415

Repair esophagus wound

Surgery - Digestive

$2,415

—

43420

Repair esophagus opening

Surgery - Digestive

$879

—

43425

Repair esophagus opening

Surgery - Digestive

$1,376

—

43450

Dilate esophagus 1/mult pass

Surgery - Digestive

$73

—

43453

Dilate esophagus

Surgery - Digestive

$77

—

43460

Pressure treatment esophagus

Surgery - Digestive

$188

—

43478027361

HYDROCORTISONE 0.1% SOLN

Prescription Drug - Generic

$3

—

43485010160

SPRITAM 250 MG TABLET

Prescription Drug - Brand

$10

—

43485010260

SPRITAM 500 MG TABLET

Prescription Drug - Brand

$10

—

43485010360

SPRITAM 750 MG TABLET

Prescription Drug - Brand

$10

—

43485010460

SPRITAM 1,000 MG TABLET

Prescription Drug - Brand

$10

—

43497

Transorl lwr esophgl myotomy

Surgery - Digestive

$718

—

43500

Surgical opening of stomach

Surgery - Digestive

$752

—

43501

Surgical repair of stomach

Surgery - Digestive

$1,269

—

43502

Surgical repair of stomach

Surgery - Digestive

$1,423

—

43510

Surgical opening of stomach

Surgery - Digestive

$904

—

My Cost List