Prescription Drug - Brand Procedure Costs — 3320 Procedures

52937000340

VASCEPA 0.5 GM CAPSULE

Prescription Drug - Brand

$2

—

53014040410

SEMPREX-D 60 MG/8 MG CAPSULE

Prescription Drug - Brand

$3

—

53014054801

TUSSIONEX PENNKINETIC SUSP

Prescription Drug - Brand

$1

—

53014057907

METADATE CD 10 MG CAPSULE

Prescription Drug - Brand

$7

—

53014058007

METADATE CD 20 MG CAPSULE

Prescription Drug - Brand

$7

—

53014058107

METADATE CD 30 MG CAPSULE

Prescription Drug - Brand

$7

—

53014058207

METADATE CD 40 MG CAPSULE

Prescription Drug - Brand

$10

—

53014058307

METADATE CD 50 MG CAPSULE

Prescription Drug - Brand

$12

—

53014058407

METADATE CD 60 MG CAPSULE

Prescription Drug - Brand

$12

—

53329016104

REMEDY SKIN REPAIR CREAM

Prescription Drug - Brand

$0

—

53329016444

REMEDY CALAZIME PROTECT PASTE

Prescription Drug - Brand

$0

—

53436008430

VELTASSA 8.4 GM POWDER PACKET

Prescription Drug - Brand

$34

—

53436016830

VELTASSA 16.8 GM POWDER PACKET

Prescription Drug - Brand

$34

—

53451010101

HORIZANT ER 600 MG TABLET

Prescription Drug - Brand

$18

—

53451010301

HORIZANT ER 300 MG TABLET

Prescription Drug - Brand

$18

—

54092017112

CARBATROL ER 100 MG CAPSULE

Prescription Drug - Brand

$2

—

54092017212

CARBATROL ER 200 MG CAPSULE

Prescription Drug - Brand

$2

—

54092017312

CARBATROL ER 300 MG CAPSULE

Prescription Drug - Brand

$2

—

54092018981

PENTASA 250 MG CAPSULE

Prescription Drug - Brand

$3

—

54092019112

PENTASA 500 MG CAPSULE

Prescription Drug - Brand

$6

—

54092025245

FOSRENOL 500 MG TABLET CHEW

Prescription Drug - Brand

$12

—

54092025490

FOSRENOL 1,000 MG TABLET CHEW

Prescription Drug - Brand

$12

—

54092038101

ADDERALL XR 5 MG CAPSULE

Prescription Drug - Brand

$7

—

54092038301

ADDERALL XR 10 MG CAPSULE

Prescription Drug - Brand

$7

—

54092038501

ADDERALL XR 15 MG CAPSULE

Prescription Drug - Brand

$7

—

54092038701

ADDERALL XR 20 MG CAPSULE

Prescription Drug - Brand

$7

—

54092038901

ADDERALL XR 25 MG CAPSULE

Prescription Drug - Brand

$7

—

54092039101

ADDERALL XR 30 MG CAPSULE

Prescription Drug - Brand

$7

—

54092046801

MYDAYIS ER 12.5 MG CAPSULE

Prescription Drug - Brand

$11

—

54092047101

MYDAYIS ER 25 MG CAPSULE

Prescription Drug - Brand

$11

—

54092047401

MYDAYIS ER 37.5 MG CAPSULE

Prescription Drug - Brand

$11

—

54092047612

LIALDA DR 1.2 GM TABLET

Prescription Drug - Brand

$9

—

54092047701

MYDAYIS ER 50 MG CAPSULE

Prescription Drug - Brand

$11

—

54092051302

INTUNIV ER 1 MG TABLET

Prescription Drug - Brand

$9

—

54092051502

INTUNIV ER 2 MG TABLET

Prescription Drug - Brand

$9

—

54092051702

INTUNIV ER 3 MG TABLET

Prescription Drug - Brand

$9

—

54092051902

INTUNIV ER 4 MG TABLET

Prescription Drug - Brand

$9

—

54092054601

MOTEGRITY 1 MG TABLET

Prescription Drug - Brand

$18

—

54092054701

MOTEGRITY 2 MG TABLET

Prescription Drug - Brand

$18

—

54123011430

ZUBSOLV 11.4-2.9 MG TABLET SL

Prescription Drug - Brand

$21

—

54123090730

ZUBSOLV 0.7-0.18 MG TABLET SL

Prescription Drug - Brand

$5

—

54123091430

ZUBSOLV 1.4-0.36 MG TABLET SL

Prescription Drug - Brand

$5

—

54123092930

ZUBSOLV 2.9-0.71 MG TABLET SL

Prescription Drug - Brand

$11

—

54123095730

ZUBSOLV 5.7-1.4 MG TABLET SL

Prescription Drug - Brand

$11

—

54123098630

ZUBSOLV 8.6-2.1 MG TABLET SL

Prescription Drug - Brand

$16

—

54436001504

OTREXUP 15 MG/0.4 ML AUTO-INJ

Prescription Drug - Brand

$484

—

54436001704

OTREXUP 17.5 MG/0.4 ML AUTOINJ

Prescription Drug - Brand

$477

—

54436002004

OTREXUP 20 MG/0.4 ML AUTO-INJ

Prescription Drug - Brand

$481

—

54436002504

OTREXUP 25 MG/0.4 ML AUTO-INJ

Prescription Drug - Brand

$476

—

54436020004

XYOSTED 100 MG/0.5 ML AUTO-INJ

Prescription Drug - Brand

$317

—

Prescription Drug - Brand Procedures

My Cost List