Medical Procedure Costs

55250

Removal of sperm duct(s)

Surgery - Male Genital

$218

—

55253007130

FENTANYL CITRATE OTFC 400 MCG

Prescription Drug - Generic

$10

—

55253007230

FENTANYL CITRATE OTFC 600 MCG

Prescription Drug - Generic

$12

—

55253007430

FENTANYL CIT OTFC 1,200 MCG

Prescription Drug - Generic

$17

—

55300

Prepare sperm duct x-ray

Surgery - Male Genital

$165

—

55390000401

GLUCAGEN 1 MG VIAL

Prescription Drug - Brand

$163

—

55400

Repair of sperm duct

Surgery - Male Genital

$457

—

55466010419

LEVO-T 25 MCG TABLET

Prescription Drug - Generic

$0

—

55466010519

LEVO-T 50 MCG TABLET

Prescription Drug - Generic

$0

—

55466010619

LEVO-T 75 MCG TABLET

Prescription Drug - Generic

$0

—

55466010711

LEVO-T 88 MCG TABLET

Prescription Drug - Generic

$0

—

55466010819

LEVO-T 100 MCG TABLET

Prescription Drug - Generic

$0

—

55466010911

LEVO-T 112 MCG TABLET

Prescription Drug - Generic

$0

—

55466011019

LEVO-T 125 MCG TABLET

Prescription Drug - Generic

$0

—

55466011111

LEVO-T 137 MCG TABLET

Prescription Drug - Generic

$0

—

55466011211

LEVO-T 150 MCG TABLET

Prescription Drug - Generic

$0

—

55466011311

LEVO-T 175 MCG TABLET

Prescription Drug - Generic

$0

—

55466011411

LEVO-T 200 MCG TABLET

Prescription Drug - Generic

$0

—

55466011511

LEVO-T 300 MCG TABLET

Prescription Drug - Generic

$0

—

55494010010

DICLEGIS DR 10-10 MG TABLET

Prescription Drug - Brand

$2

—

55494012060

BONJESTA ER 20-20 MG TABLET

Prescription Drug - Brand

$11

—

55494058090

OSPHENA 60 MG TABLET

Prescription Drug - Brand

$8

—

55500

Removal of hydrocele

Surgery - Male Genital

$368

—

55513002104

ARANESP 40 MCG/0.4 ML SYRINGE

Prescription Drug - Brand

$753

—

55513002504

ARANESP 100 MCG/0.5 ML SYRINGE

Prescription Drug - Brand

$1,428

—

55513005704

ARANESP 25 MCG/0.42 ML SYRING

Prescription Drug - Brand

$450

—

55513007330

SENSIPAR 30 MG TABLET

Prescription Drug - Brand

$26

—

55513007430

SENSIPAR 60 MG TABLET

Prescription Drug - Brand

$52

—

55513007530

SENSIPAR 90 MG TABLET

Prescription Drug - Brand

$78

—

55513012610

EPOGEN 2,000 UNITS/ML VIAL

Prescription Drug - Brand

$32

—

55513013760

OTEZLA 30 MG TABLET

Prescription Drug - Brand

$91

—

55513014410

EPOGEN 10,000 UNITS/ML VIAL

Prescription Drug - Brand

$162

—

55513014810

EPOGEN 4,000 UNITS/ML VIAL

Prescription Drug - Brand

$64

—

55513019001

NEULASTA 6 MG/0.6 ML SYRINGE

Prescription Drug - Brand

$10,075

—

55513020910

NEUPOGEN 480 MCG/0.8 ML SYR

Prescription Drug - Brand

$636

—

55513036955

OTEZLA 10-20-30 MG START 28 DAY

Prescription Drug - Brand

$99

—

55513049760

OTEZLA 20 MG TABLET

Prescription Drug - Brand

$90

—

55513053010

NEUPOGEN 300 MCG/ML VIAL

Prescription Drug - Brand

$306

—

55513071021

PROLIA 60 MG/ML SYRINGE

Prescription Drug - Brand

$1,864

—

55513073021

XGEVA 120 MG/1.7 ML VIAL

Prescription Drug - Brand

$2,002

—

55513080060

CORLANOR 5 MG TABLET

Prescription Drug - Brand

$10

—

55513081060

CORLANOR 7.5 MG TABLET

Prescription Drug - Brand

$10

—

55513084101

AIMOVIG 70 MG/ML AUTOINJECTOR

Prescription Drug - Brand

$753

—

55513084301

AIMOVIG 140 MG/ML AUTOINJECTOR

Prescription Drug - Brand

$754

—

55513092491

NEUPOGEN 300 MCG/0.5 ML SYR

Prescription Drug - Brand

$651

—

55520

Removal of sperm cord lesion

Surgery - Male Genital

$450

—

55530

Revise spermatic cord veins

Surgery - Male Genital

$327

—

55535

Revise spermatic cord veins

Surgery - Male Genital

$398

—

55540

Revise hernia & sperm veins

Surgery - Male Genital

$540

—

55550

Laparo ligate spermatic vein

Surgery - Male Genital

$397

—

My Cost List