Prescription Drug - Brand Procedure Costs — 3320 Procedures

00169300315

NOVOLIN R 100 UNIT/ML FLEXPEN

Prescription Drug - Brand

$6

—

00169300415

NOVOLIN N 100 UNIT/ML FLEXPEN

Prescription Drug - Brand

$6

—

00169300715

NOVOLIN 70-30 FLEXPEN

Prescription Drug - Brand

$6

—

00169320111

FIASP 100 UNIT/ML VIAL

Prescription Drug - Brand

$7

—

00169320415

FIASP 100 UNIT/ML FLEXTOUCH

Prescription Drug - Brand

$9

—

00169320515

FIASP PENFILL 100 UNIT/ML CART

Prescription Drug - Brand

$9

—

00169320615

FIASP PUMPCART 100 UNIT/ML

Prescription Drug - Brand

$9

—

00169330312

NOVOLOG PENFILL 100 UNIT/ML

Prescription Drug - Brand

$9

—

00169368512

NOVOLOG MIX 70-30 VIAL

Prescription Drug - Brand

$7

—

00169368712

LEVEMIR 100 UNITS/ML VIAL

Prescription Drug - Brand

$30

—

00169369619

NOVOLOG MIX 70-30 FLEXPEN

Prescription Drug - Brand

$9

—

00169406012

VICTOZA 2-PAK 18 MG/3 ML PEN

Prescription Drug - Brand

$88

—

00169406013

VICTOZA 3-PAK 18 MG/3 ML PEN

Prescription Drug - Brand

$88

—

00169413013

OZEMPIC 1 MG/DOSE (4 MG/3 ML) PEN

Prescription Drug - Brand

$332

—

00169413211

OZEMPIC 0.25-0.5 MG DOSE PEN

Prescription Drug - Brand

$545

—

00169413212

OZEMPIC 0.25-0.5 MG/DOSE (2 MG/1.5 ML) PEN

Prescription Drug - Brand

$639

—

00169413602

OZEMPIC 1 MG DOSE PEN

Prescription Drug - Brand

$272

—

00169418113

OZEMPIC 0.25-0.5 MG/DOSE (2 MG/3 ML) PEN

Prescription Drug - Brand

$332

—

00169430330

RYBELSUS 3 MG TABLET

Prescription Drug - Brand

$33

—

00169430730

RYBELSUS 7 MG TABLET

Prescription Drug - Brand

$33

—

00169431430

RYBELSUS 14 MG TABLET

Prescription Drug - Brand

$33

—

00169450114

WEGOVY 1 MG/0.5 ML PEN

Prescription Drug - Brand

$653

—

00169450514

WEGOVY 0.5 MG/0.5 ML PEN

Prescription Drug - Brand

$654

—

00169451714

WEGOVY 1.7 MG/0.75 ML PEN

Prescription Drug - Brand

$436

—

00169452414

WEGOVY 2.4 MG/0.75 ML PEN

Prescription Drug - Brand

$435

—

00169452514

WEGOVY 0.25 MG/0.5 ML PEN

Prescription Drug - Brand

$654

—

00169477212

OZEMPIC 2 MG/DOSE (8 MG/3 ML) PEN

Prescription Drug - Brand

$332

—

00169517402

ACTIVELLA 1 MG-0.5 MG TABLET

Prescription Drug - Brand

$6

—

00169517604

VAGIFEM 10 MCG VAGINAL TAB

Prescription Drug - Brand

$20

—

00169633910

NOVOLOG 100 UNIT/ML FLEXPEN

Prescription Drug - Brand

$9

—

00169643210

LEVEMIR FLEXPEN 100 UNIT/ML

Prescription Drug - Brand

$10

—

00169643810

LEVEMIR FLEXTOUCH 100 UNITS/ML

Prescription Drug - Brand

$30

—

00169643910

LEVEMIR FLEXPEN 100 UNITS/ML

Prescription Drug - Brand

$26

—

00169706515

GLUCAGEN 1 MG HYPOKIT

Prescription Drug - Brand

$295

—

00169750111

NOVOLOG 100 UNIT/ML VIAL

Prescription Drug - Brand

$7

—

00169770421

NORDITROPIN FLEXPRO 5 MG/1.5

Prescription Drug - Brand

$571

—

00169770521

NORDITROPIN FLEXPRO 10 MG/1.5

Prescription Drug - Brand

$1,143

—

00169770821

NORDITROPIN FLEXPRO 15 MG/1.5

Prescription Drug - Brand

$1,718

—

00173013555

WELLBUTRIN SR 150 MG TABLET

Prescription Drug - Brand

$8

—

00173017855

WELLBUTRIN 100 MG TABLET

Prescription Drug - Brand

$3

—

00173038879

BECONASE AQ 0.042% SPRAY

Prescription Drug - Brand

$11

—

00173039340

ZANTAC 300 MG TABLET

Prescription Drug - Brand

$11

—

00173045301

FLONASE 0.05% NASAL SPRAY

Prescription Drug - Brand

$6

—

00173047800

IMITREX 6 MG/0.5 ML CARTRIDGES

Prescription Drug - Brand

$437

—

00173047900

IMITREX 6 MG/0.5 ML PEN INJECT

Prescription Drug - Brand

$462

—

00173052100

SEREVENT DISKUS 50 MCG

Prescription Drug - Brand

$7

—

00173052300

IMITREX 20 MG NASAL SPRAY

Prescription Drug - Brand

$89

—

00173052400

IMITREX 5 MG NASAL SPRAY

Prescription Drug - Brand

$89

—

00173052700

LAMICTAL 25 MG DISPER TABLET

Prescription Drug - Brand

$11

—

00173056200

AMERGE 2.5 MG TABLET

Prescription Drug - Brand

$54

—

Prescription Drug - Brand Procedures

My Cost List