Medical Procedure Costs

00069024430

TOVIAZ ER 8 MG TABLET

Prescription Drug - Brand

$9

—

00069033530

CIBINQO 100 MG TABLET

Prescription Drug - Brand

$197

—

00069033621

REVATIO 10 MG/ML ORAL SUSP

Prescription Drug - Brand

$88

—

00069046856

CHANTIX 0.5 MG TABLET

Prescription Drug - Brand

$8

—

00069046903

CHANTIX 1 MG CONT MONTH BOX

Prescription Drug - Brand

$8

—

00069046956

CHANTIX 1 MG TABLET

Prescription Drug - Brand

$8

—

00069047103

CHANTIX STARTING MONTH BOX

Prescription Drug - Brand

$8

—

00069050130

XELJANZ XR 11 MG TABLET

Prescription Drug - Brand

$208

—

00069052111

PAXLOVID 300/150-100 MG DOSE PACK (SEVERE RENAL DOSE)

Prescription Drug - Brand

$134

—

00069055038

SUTENT 12.5 MG CAPSULE

Prescription Drug - Brand

$222

—

00069077038

SUTENT 25 MG CAPSULE

Prescription Drug - Brand

$449

—

00069080901

INFLECTRA 100 MG VIAL

Prescription Drug - Brand

$492

—

00069100101

XELJANZ 5 MG TABLET

Prescription Drug - Brand

$74

—

00069100201

XELJANZ 10 MG TABLET

Prescription Drug - Brand

$104

—

00069130510

RETACRIT 2,000 UNIT/ML VIAL

Prescription Drug - Brand

$22

—

00069130810

RETACRIT 10,000 UNIT/ML VIAL

Prescription Drug - Brand

$110

—

00069131110

RETACRIT 20,000 UNIT/ML VIAL

Prescription Drug - Brand

$219

—

00069215030

CADUET 5 MG-10 MG TABLET

Prescription Drug - Brand

$14

—

00069216030

CADUET 10 MG-10 MG TABLET

Prescription Drug - Brand

$14

—

00069217030

CADUET 5 MG-20 MG TABLET

Prescription Drug - Brand

$19

—

00069218030

CADUET 10 MG-20 MG TABLET

Prescription Drug - Brand

$19

—

00069219030

CADUET 5 MG-40 MG TABLET

Prescription Drug - Brand

$19

—

00069225030

CADUET 10 MG-40 MG TABLET

Prescription Drug - Brand

$19

—

00069226030

CADUET 5 MG-80 MG TABLET

Prescription Drug - Brand

$19

—

00069227030

CADUET 10 MG-80 MG TABLET

Prescription Drug - Brand

$19

—

00069265072

PROCARDIA XL 30 MG TABLET

Prescription Drug - Brand

$6

—

00069266072

PROCARDIA XL 60 MG TABLET

Prescription Drug - Brand

$10

—

00069306075

ZITHROMAX 250 MG Z-PAK TABLET

Prescription Drug - Brand

$2

—

00069350002

ZAVZPRET 10 MG NASAL SPRAY

Prescription Drug - Brand

$190

—

00069406189

ZITHROMAX 250 MG TABLET

Prescription Drug - Brand

$2

—

00069419068

REVATIO 20 MG TABLET

Prescription Drug - Brand

$47

—

00069420030

VIAGRA 25 MG TABLET

Prescription Drug - Brand

$75

—

00069421066

VIAGRA 50 MG TABLET

Prescription Drug - Brand

$74

—

00069531720

PAXLOVID 150-100 MG DOSE PACK (RENAL DOSE)

Prescription Drug - Brand

$72

—

00069532130

PAXLOVID 300-100 MG DOSE PACK

Prescription Drug - Brand

$49

—

00069543420

PAXLOVID 150-100 MG DOSE PACK (MODERATE RENAL DOSE)

Prescription Drug - Brand

$74

—

00069580061

TIKOSYN 125 MCG CAPSULE

Prescription Drug - Brand

$10

—

00069581060

TIKOSYN 250 MCG CAPSULE

Prescription Drug - Brand

$10

—

00069582061

TIKOSYN 500 MCG CAPSULE

Prescription Drug - Brand

$11

—

0006M

Molecular pathology test for genetic analysis of liver tumor (HeproDX)

Pathology/Laboratory

$150

—

00071000740

DILANTIN 50 MG INFATAB

Prescription Drug - Brand

$2

—

00071023724

ZARONTIN 250 MG CAPSULE

Prescription Drug - Brand

$1

—

00071035060

NARDIL 15 MG TABLET

Prescription Drug - Brand

$3

—

00071041724

NITROSTAT 0.3 MG TABLET SL

Prescription Drug - Brand

$1

—

00071041924

NITROSTAT 0.6 MG TABLET SL

Prescription Drug - Brand

$1

—

00071052524

CELONTIN 300 MG CAPSULE

Prescription Drug - Brand

$4

—

00071053023

ACCUPRIL 10 MG TABLET

Prescription Drug - Brand

$5

—

00071053223

ACCUPRIL 20 MG TABLET

Prescription Drug - Brand

$5

—

00071053523

ACCUPRIL 40 MG TABLET

Prescription Drug - Brand

$5

—

00071080524

NEURONTIN 300 MG CAPSULE

Prescription Drug - Brand

$7

—

My Cost List