Prescription Drug - Brand Procedure Costs — 3320 Procedures

71858003004

TIROSINT 100 MCG CAPSULE

Prescription Drug - Brand

$4

—

71858003504

TIROSINT 112 MCG CAPSULE

Prescription Drug - Brand

$4

—

71858004004

TIROSINT 125 MCG CAPSULE

Prescription Drug - Brand

$5

—

71858004504

TIROSINT 137 MCG CAPSULE

Prescription Drug - Brand

$4

—

71858005004

TIROSINT 150 MCG CAPSULE

Prescription Drug - Brand

$5

—

71858005504

TIROSINT 175 MCG CAPSULE

Prescription Drug - Brand

$4

—

71858006004

TIROSINT 200 MCG CAPSULE

Prescription Drug - Brand

$4

—

71858010505

TIROSINT-SOL 13 MCG/ML SOLN

Prescription Drug - Brand

$5

—

71858011005

TIROSINT-SOL 25 MCG/ML SOLN

Prescription Drug - Brand

$5

—

71858011205

TIROSINT-SOL 37.5 MCG/ML SOLN

Prescription Drug - Brand

$4

—

71858011505

TIROSINT-SOL 50 MCG/ML SOLN

Prescription Drug - Brand

$5

—

71858011705

TIROSINT-SOL 62.5 MCG/ML SOLN

Prescription Drug - Brand

$5

—

71858012005

TIROSINT-SOL 75 MCG/ML SOLN

Prescription Drug - Brand

$5

—

71858012505

TIROSINT-SOL 88 MCG/ML SOLN

Prescription Drug - Brand

$5

—

71858013005

TIROSINT-SOL 100 MCG/ML SOLN

Prescription Drug - Brand

$5

—

71858013505

TIROSINT-SOL 112 MCG/ML SOLN

Prescription Drug - Brand

$4

—

71858014005

TIROSINT-SOL 125 MCG/ML SOLN

Prescription Drug - Brand

$5

—

71858014505

TIROSINT-SOL 137 MCG/ML SOLN

Prescription Drug - Brand

$4

—

71858015005

TIROSINT-SOL 150 MCG/ML SOLN

Prescription Drug - Brand

$5

—

71858015505

TIROSINT-SOL 175 MCG/ML SOLN

Prescription Drug - Brand

$5

—

71858016005

TIROSINT-SOL 200 MCG/ML SOLN

Prescription Drug - Brand

$5

—

71858030505

LICART 1.3% PATCH

Prescription Drug - Brand

$25

—

71858040505

FLECTOR 1.3% PATCH

Prescription Drug - Brand

$10

—

72060011040

CAPLYTA 10.5 MG CAPSULE

Prescription Drug - Brand

$57

—

72060012140

CAPLYTA 21 MG CAPSULE

Prescription Drug - Brand

$57

—

72060014240

CAPLYTA 42 MG CAPSULE

Prescription Drug - Brand

$57

—

72065012012

GVOKE HYPOPEN 2PK 0.5 MG/0.1 ML

Prescription Drug - Brand

$3,205

—

72065012111

GVOKE HYPOPEN 1-PK 1 MG/0.2 ML

Prescription Drug - Brand

$1,602

—

72065012112

GVOKE HYPOPEN 2-PK 1 MG/0.2 ML

Prescription Drug - Brand

$1,600

—

72065013111

GVOKE PFS 1-PK 1 MG/0.2 ML SYR

Prescription Drug - Brand

$1,604

—

72065013112

GVOKE PFS 2-PK 1 MG/0.2 ML SYR

Prescription Drug - Brand

$1,607

—

72065014011

GVOKE 1 MG/0.2 ML KIT

Prescription Drug - Brand

$1,604

—

72065014111

GVOKE 1 MG/0.2 ML VIAL

Prescription Drug - Brand

$1,604

—

72252050505

VALTOCO 5 MG NASAL SPRAY

Prescription Drug - Brand

$366

—

72252051005

VALTOCO 10 MG NASAL SPRAY

Prescription Drug - Brand

$366

—

72252051510

VALTOCO 15 MG NASAL SPRAY

Prescription Drug - Brand

$366

—

72252052010

VALTOCO 20 MG NASAL SPRAY

Prescription Drug - Brand

$365

—

72305002590

EUTHYROX 25 MCG TABLET

Prescription Drug - Brand

$0

—

72305005090

EUTHYROX 50 MCG TABLET

Prescription Drug - Brand

$0

—

72305007590

EUTHYROX 75 MCG TABLET

Prescription Drug - Brand

$0

—

72305008890

EUTHYROX 88 MCG TABLET

Prescription Drug - Brand

$0

—

72305010090

EUTHYROX 100 MCG TABLET

Prescription Drug - Brand

$0

—

72305011290

EUTHYROX 112 MCG TABLET

Prescription Drug - Brand

$0

—

72305012590

EUTHYROX 125 MCG TABLET

Prescription Drug - Brand

$0

—

72305013790

EUTHYROX 137 MCG TABLET

Prescription Drug - Brand

$0

—

72305015090

EUTHYROX 150 MCG TABLET

Prescription Drug - Brand

$0

—

72305017590

EUTHYROX 175 MCG TABLET

Prescription Drug - Brand

$0

—

72305020090

EUTHYROX 200 MCG TABLET

Prescription Drug - Brand

$0

—

72356010103

AMZEEQ 4% FOAM

Prescription Drug - Brand

$16

—

72426011803

NEXLETOL 180 MG TABLET

Prescription Drug - Brand

$14

—

Prescription Drug - Brand Procedures

My Cost List