Medical Procedure Costs

58151036896

RELPAX 40 MG TABLET

Prescription Drug - Brand

$77

—

58151041935

XALATAN 0.005% EYE DROPS

Prescription Drug - Brand

$108

—

58151042893

VIAGRA 100 MG TABLET

Prescription Drug - Brand

$84

—

58151045201

XANAX 0.25 MG TABLET

Prescription Drug - Brand

$6

—

58151045305

XANAX 0.5 MG TABLET

Prescription Drug - Brand

$7

—

58151045401

XANAX 1 MG TABLET

Prescription Drug - Brand

$9

—

58151045501

XANAX 2 MG TABLET

Prescription Drug - Brand

$16

—

58151057493

ZOLOFT 25 MG TABLET

Prescription Drug - Brand

$15

—

58151057593

ZOLOFT 50 MG TABLET

Prescription Drug - Brand

$15

—

58151057693

ZOLOFT 100 MG TABLET

Prescription Drug - Brand

$15

—

58152

Total hysterectomy

Surgery - Female Genital

$1,090

—

58180

Partial hysterectomy

Surgery - Female Genital

$867

—

58200

Extensive hysterectomy

Surgery - Female Genital

$1,257

—

58210

Extensive hysterectomy

Surgery - Female Genital

$1,678

—

58223068424

FLURA-DROPS 0.25 MG/DROP

Prescription Drug - Generic

$0

—

58240

Removal of pelvis contents

Surgery - Female Genital

$2,678

—

58260

Vaginal hysterectomy

Surgery - Female Genital

$742

—

58262

Vag hyst including t/o

Surgery - Female Genital

$819

—

58263

Vag hyst w/t/o & vag repair

Surgery - Female Genital

$877

—

58267

Vag hyst w/urinary repair

Surgery - Female Genital

$940

—

58270

Vag hyst w/enterocele repair

Surgery - Female Genital

$794

—

58275

Hysterectomy/revise vagina

Surgery - Female Genital

$876

—

58280

Hysterectomy/revise vagina

Surgery - Female Genital

$933

—

58285

Extensive hysterectomy

Surgery - Female Genital

$1,329

—

58290

Vag hyst complex

Surgery - Female Genital

$1,011

—

58291

Vag hyst incl t/o complex

Surgery - Female Genital

$1,093

—

58292

Vag hyst t/o & repair compl

Surgery - Female Genital

$1,151

—

58294

Vag hyst w/enterocele compl

Surgery - Female Genital

$1,070

—

58301

Remove intrauterine device

Surgery - Female Genital

$58

—

58321

Artificial insemination

Surgery - Female Genital

$42

—

58322

Artificial insemination

Surgery - Female Genital

$50

—

58323

Sperm washing

Surgery - Female Genital

$10

—

58340

Catheter for hysterography

Surgery - Female Genital

$52

—

58345

Reopen fallopian tube

Surgery - Female Genital

$255

—

58346

Insert heyman uteri capsule

Surgery - Female Genital

$420

—

58350

Reopen fallopian tube

Surgery - Female Genital

$84

—

58353

Endometr ablate thermal

Surgery - Female Genital

$204

—

58356

Endometrial cryoablation

Surgery - Female Genital

$306

—

58400

Suspension of uterus

Surgery - Female Genital

$416

—

58406001004

ENBREL 25 MG/0.5 ML SYRINGE

Prescription Drug - Brand

$2,076

—

58406002104

ENBREL 50 MG/ML SYRINGE

Prescription Drug - Brand

$2,081

—

58406003204

ENBREL 50 MG/ML SURECLICK

Prescription Drug - Brand

$2,083

—

58406004404

ENBREL 50 MG/ML MINI CARTRIDGE

Prescription Drug - Brand

$2,082

—

58406042534

ENBREL 25 MG KIT

Prescription Drug - Brand

$727

—

58406044504

ENBREL 50 MG/ML SURECLICK SYR

Prescription Drug - Brand

$1,287

—

58407053401

CAPACET CAPSULE

Prescription Drug - Generic

$2

—

58407062530

STAHIST AD TABLET

Prescription Drug - Brand

$1

—

58410

Suspension of uterus

Surgery - Female Genital

$720

—

58468002001

RENAGEL 400 MG TABLET

Prescription Drug - Brand

$3

—

58468002101

RENAGEL 800 MG TABLET

Prescription Drug - Brand

$7

—

My Cost List