Medical Procedure Costs

55566101001

FYREMADEL 250 MCG/0.5 ML SYR

Prescription Drug - Generic

$62

—

55566150101

NOVAREL 10,000 UNITS VIAL

Prescription Drug - Generic

$191

—

55566150201

NOVAREL 5,000 UNIT VIAL

Prescription Drug - Brand

$170

—

55566180101

ZOMACTON 5 MG VIAL

Prescription Drug - Brand

$281

—

55566190101

ZOMACTON 10 MG VIAL

Prescription Drug - Brand

$559

—

55566211002

LYSTEDA 650 MG TABLET

Prescription Drug - Brand

$5

—

55566650003

ENDOMETRIN 100 MG VAG INSERT

Prescription Drug - Brand

$15

—

55566670001

CLENPIQ SOLUTION

Prescription Drug - Brand

$0

—

55566680001

CLENPIQ 175 ML SOLUTION

Prescription Drug - Brand

$1

—

55566750102

MENOPUR 75 UNIT VIAL

Prescription Drug - Brand

$243

—

55566970001

PREPOPIK POWDER PACKET

Prescription Drug - Brand

$66

—

55600

Vesiculotomy

Surgery - Male Genital

$390

—

55605

Vesiculotomy complicated

Surgery - Male Genital

$482

—

55650

Remove sperm duct pouch

Surgery - Male Genital

$652

—

55680

Remove sperm pouch lesion

Surgery - Male Genital

$322

—

55705

Bx prst8 any approach nonimg

Surgery - Male Genital

$100

—

55706

Bx prst8 ndl sat sampling

Surgery - Male Genital

$203

—

55707

Bx prst8 trct us guided

Surgery - Male Genital

$136

—

55708

Bx prst8 trct us w/mri fus 1

Surgery - Male Genital

$170

—

55709

Bx prst8 tprnl us guided

Surgery - Male Genital

$163

—

55710

Bx prst8 tprn us w/mri fus 1

Surgery - Male Genital

$188

—

55711

Bx prst8 trct mri-us 1st

Surgery - Male Genital

$136

—

55712

Bx prst8 tprnl mri-us 1st

Surgery - Male Genital

$158

—

55713

Bx prst8 in-bore ct/mri bx 1

Surgery - Male Genital

$186

—

55714

Bx prst8 in-bore ct/mri 1

Surgery - Male Genital

$169

—

55715

Bx prst8 ea add mri-us/ct/mr

Surgery - Male Genital

$47

—

55720

Drainage of prostate abscess

Surgery - Male Genital

$415

—

55724021121

EUCRISA 2% OINTMENT

Prescription Drug - Brand

$13

—

55725

Drainage of prostate abscess

Surgery - Male Genital

$547

—

55801

Removal of prostate

Surgery - Male Genital

$983

—

55810

Extensive prostate surgery

Surgery - Male Genital

$1,165

—

55812

Extensive prostate surgery

Surgery - Male Genital

$1,431

—

55815

Extensive prostate surgery

Surgery - Male Genital

$1,564

—

55821

Removal of prostate

Surgery - Male Genital

$755

—

55831

Removal of prostate

Surgery - Male Genital

$775

—

55840

Extensive prostate surgery

Surgery - Male Genital

$1,045

—

55842

Extensive prostate surgery

Surgery - Male Genital

$1,043

—

55845

Extensive prostate surgery

Surgery - Male Genital

$1,209

—

55860

Surgical exposure prostate

Surgery - Male Genital

$786

—

55862

Extensive prostate surgery

Surgery - Male Genital

$981

—

55865

Extensive prostate surgery

Surgery - Male Genital

$1,191

—

55866

Laps surg prst8ect rpbic rad

Surgery - Male Genital

$1,082

—

55867

Laps surg prst8ect smpl stot

Surgery - Male Genital

$946

—

55868

Lap srg prst8ct lymph nod bx

Surgery - Male Genital

$1,108

—

55869

Lap srg prst8ct bi pl lmphad

Surgery - Male Genital

$1,329

—

55870

Electroejaculation

Surgery - Male Genital

$128

—

55873

Cryoablate prostate

Surgery - Male Genital

$688

—

55874

Tprnl plmt biodegrdabl matrl

Surgery - Male Genital

$143

—

55875

Transperi needle place pros

Surgery - Male Genital

$688

—

55876

Place rt device/marker pros

Surgery - Male Genital

$91

—

My Cost List