Prescription Drug - Brand Procedure Costs — 3320 Procedures

00573286810

PREPARATION H CREAM

Prescription Drug - Brand

$0

—

00573287120

PREPARATION H OINTMENT

Prescription Drug - Brand

$0

—

00573288320

PREPARATION H SUPPOSITORY

Prescription Drug - Brand

$0

—

00573295220

PRIMATENE ASTHMA TABLET

Prescription Drug - Brand

$0

—

00574206727

EVAMIST 1.53 MG/SPRAY

Prescription Drug - Brand

$18

—

00574722612

COMPRO 25 MG SUPPOSITORY

Prescription Drug - Brand

$6

—

00575620030

PROGLYCEM 50 MG/ML ORAL SUSP

Prescription Drug - Brand

$17

—

00597000160

AGGRENOX 25 MG-200 MG CAPSULE

Prescription Drug - Brand

$9

—

00597000302

APTIVUS 250 MG CAPSULE

Prescription Drug - Brand

$17

—

00597000701

CATAPRES 0.2 MG TABLET

Prescription Drug - Brand

$4

—

00597001259

DULCOLAX EC 5 MG TABLET

Prescription Drug - Brand

$0

—

00597002402

COMBIVENT RESPIMAT 20-100 MCG

Prescription Drug - Brand

$124

—

00597002901

MOBIC 7.5 MG TABLET

Prescription Drug - Brand

$10

—

00597003001

MOBIC 15 MG TABLET

Prescription Drug - Brand

$14

—

00597003134

CATAPRES-TTS 1 PATCH

Prescription Drug - Brand

$67

—

00597003234

CATAPRES-TTS 2 PATCH

Prescription Drug - Brand

$113

—

00597003334

CATAPRES-TTS 3 PATCH

Prescription Drug - Brand

$163

—

00597003937

MICARDIS 20 MG TABLET

Prescription Drug - Brand

$7

—

00597004037

MICARDIS 40 MG TABLET

Prescription Drug - Brand

$5

—

00597004137

MICARDIS 80 MG TABLET

Prescription Drug - Brand

$4

—

00597004237

MICARDIS HCT 80-25 MG TABLET

Prescription Drug - Brand

$4

—

00597004337

MICARDIS HCT 40-12.5 MG TABLET

Prescription Drug - Brand

$4

—

00597004437

MICARDIS HCT 80-12.5 MG TABLET

Prescription Drug - Brand

$4

—

00597004660

VIRAMUNE 200 MG TABLET

Prescription Drug - Brand

$15

—

00597007547

SPIRIVA 18 MCG CP-HANDIHALER

Prescription Drug - Brand

$16

—

00597007575

SPIRIVA HANDIHALER 18 MCG CAP

Prescription Drug - Brand

$12

—

00597008717

ATROVENT 17 MCG HFA INHALER

Prescription Drug - Brand

$23

—

00597010061

SPIRIVA RESPIMAT 2.5 MCG INH

Prescription Drug - Brand

$126

—

00597010860

PRADAXA 110 MG CAPSULE

Prescription Drug - Brand

$3

—

00597010930

MIRAPEX ER 0.375 MG TABLET

Prescription Drug - Brand

$24

—

00597011330

MIRAPEX ER 1.5 MG TABLET

Prescription Drug - Brand

$23

—

00597011530

MIRAPEX ER 3 MG TABLET

Prescription Drug - Brand

$24

—

00597011630

MIRAPEX ER 4.5 MG TABLET

Prescription Drug - Brand

$24

—

00597012150

ZANTAC 150 MG TABLET

Prescription Drug - Brand

$0

—

00597012254

ZANTAC 75 MG TABLET

Prescription Drug - Brand

$0

—

00597012330

VIRAMUNE XR 400 MG TABLET

Prescription Drug - Brand

$27

—

00597012637

TWYNSTA 80-5 MG TABLET

Prescription Drug - Brand

$7

—

00597012737

TWYNSTA 80-10 MG TABLET

Prescription Drug - Brand

$7

—

00597014090

TRADJENTA 5 MG TABLET

Prescription Drug - Brand

$17

—

00597014660

JENTADUETO 2.5 MG-500 MG TAB

Prescription Drug - Brand

$8

—

00597014760

JENTADUETO 2.5 MG-850 MG TAB

Prescription Drug - Brand

$8

—

00597014860

JENTADUETO 2.5 MG-1,000 MG TAB

Prescription Drug - Brand

$8

—

00597015290

JARDIANCE 10 MG TABLET

Prescription Drug - Brand

$11

—

00597015390

JARDIANCE 25 MG TABLET

Prescription Drug - Brand

$11

—

00597015561

STIOLTO RESPIMAT INHALER (60)

Prescription Drug - Brand

$116

—

00597015960

SYNJARDY 5-500 MG TABLET

Prescription Drug - Brand

$6

—

00597016061

SPIRIVA RESPIMAT 1.25 MCG INH

Prescription Drug - Brand

$126

—

00597016490

GLYXAMBI 25 MG-5 MG TABLET

Prescription Drug - Brand

$11

—

00597016860

SYNJARDY 12.5-1,000 MG TABLET

Prescription Drug - Brand

$6

—

00597017560

SYNJARDY 5-1,000 MG TABLET

Prescription Drug - Brand

$6

—

Prescription Drug - Brand Procedures

My Cost List