Prescription Drug - Brand Procedure Costs — 3320 Procedures

51759020210

AJOVY 225 MG/1.5 ML AUTOINJECT

Prescription Drug - Brand

$508

—

51759020222

AJOVY 225 MG/1.5 ML AUTOINJECTOR (3 PACK)

Prescription Drug - Brand

$506

—

51759020410

AJOVY 225 MG/1.5 ML SYRINGE

Prescription Drug - Brand

$508

—

51759030510

UZEDY ER 50 MG/0.14 ML SYRINGE

Prescription Drug - Brand

$9,451

—

51759041010

UZEDY ER 75 MG/0.21 ML SYRINGE

Prescription Drug - Brand

$9,362

—

51759051321

SIMLANDI(CF) 40 MG/0.4 ML AUTOINJECTOR

Prescription Drug - Brand

$489

—

51759052010

UZEDY ER 100 MG/0.28 ML SYRING

Prescription Drug - Brand

$9,394

—

51759063010

UZEDY ER 125 MG/0.35 ML SYRING

Prescription Drug - Brand

$9,430

—

51759085010

UZEDY ER 200 MG/0.56 ML SYRING

Prescription Drug - Brand

$9,394

—

51862025801

NEXTSTELLIS 3-14.2 MG TABLET

Prescription Drug - Brand

$7

—

51862029510

FABIOR 0.1% FOAM

Prescription Drug - Brand

$12

—

51862037660

SORILUX 0.005% FOAM

Prescription Drug - Brand

$13

—

51862055930

DORYX MPC DR 120 MG TABLET

Prescription Drug - Brand

$12

—

51862056060

DORYX MPC DR 60 MG TABLET

Prescription Drug - Brand

$18

—

51862058701

LORCET HD 10-325 MG TABLET

Prescription Drug - Brand

$0

—

51862068201

SOLTAMOX 20 MG/10 ML SOLN

Prescription Drug - Brand

$4

—

51862076530

RHOFADE 1% CREAM

Prescription Drug - Brand

$23

—

52015008001

DIFICID 200 MG TABLET

Prescription Drug - Brand

$249

—

52054051409

DEXEDRINE SPANSULE 15 MG

Prescription Drug - Brand

$17

—

52054055022

ALBENZA 200 MG TABLET

Prescription Drug - Brand

$232

—

52054080302

ADRENACLICK 0.15 MG AUTO-INJCT

Prescription Drug - Brand

$161

—

52054080402

ADRENACLICK 0.3 MG AUTO-INJECT

Prescription Drug - Brand

$149

—

52244002002

EDEX 20 MCG CARTRIDGE 2-PK KIT

Prescription Drug - Brand

$237

—

52244010010

THEO-24 ER 100 MG CAPSULE

Prescription Drug - Brand

$4

—

52244020010

THEO-24 ER 200 MG CAPSULE

Prescription Drug - Brand

$6

—

52244030010

THEO-24 ER 300 MG CAPSULE

Prescription Drug - Brand

$7

—

52244040010

THEO-24 ER 400 MG CAPSULE

Prescription Drug - Brand

$10

—

52244040410

SEMPREX-D 8 MG-60 MG CAPSULE

Prescription Drug - Brand

$6

—

52268001201

SUPREP BOWEL PREP KIT

Prescription Drug - Brand

$0

—

52268010001

GOLYTELY SOLUTION

Prescription Drug - Brand

$0

—

52268020101

SUTAB 1.479-0.225-0.188 GM TAB

Prescription Drug - Brand

$7

—

52268030201

NULYTELY SOLUTION

Prescription Drug - Brand

$0

—

52268040001

NULYTELY WITH FLAVOR PACKS SOL

Prescription Drug - Brand

$0

—

52268052302

HALFLYTELY-BISACODYL BOWEL KIT

Prescription Drug - Brand

$59

—

52268055101

SUFLAVE POWDER

Prescription Drug - Brand

$62

—

52268070001

GOLYTELY PACKET

Prescription Drug - Brand

$12

—

52427027430

NAPRELAN CR 750 MG TABLET

Prescription Drug - Brand

$22

—

52427028601

MACRODANTIN 25 MG CAPSULE

Prescription Drug - Brand

$11

—

52427042990

TENORMIN 25 MG TABLET

Prescription Drug - Brand

$13

—

52427043090

TENORMIN 50 MG TABLET

Prescription Drug - Brand

$13

—

52427044090

ZESTRIL 10 MG TABLET

Prescription Drug - Brand

$13

—

52427057530

FORFIVO XL 450 MG TABLET

Prescription Drug - Brand

$15

—

52427065830

LOREEV XR 1 MG CAPSULE

Prescription Drug - Brand

$14

—

52427066130

LOREEV XR 1.5 MG CAPSULE

Prescription Drug - Brand

$14

—

52427066330

LOREEV XR 2 MG CAPSULE

Prescription Drug - Brand

$14

—

52427066730

LOREEV XR 3 MG CAPSULE

Prescription Drug - Brand

$14

—

52427080390

GRALISE ER 300 MG TABLET

Prescription Drug - Brand

$10

—

52427080460

GRALISE ER 450 MG TABLET

Prescription Drug - Brand

$10

—

52427080690

GRALISE ER 600 MG TABLET

Prescription Drug - Brand

$10

—

52427085060

GRALISE ER 750 MG TABLET

Prescription Drug - Brand

$15

—

Prescription Drug - Brand Procedures

My Cost List