Medical Procedure Costs

00071102701

LYRICA CR 165 MG TABLET

Prescription Drug - Brand

$14

—

00071102901

LYRICA CR 330 MG TABLET

Prescription Drug - Brand

$14

—

00071201223

NEURONTIN 250 MG/5 ML SOLN

Prescription Drug - Brand

$1

—

00071221420

DILANTIN 125 MG/5 ML SUSP

Prescription Drug - Brand

$1

—

00074003828

ORILISSA 150 MG TABLET

Prescription Drug - Brand

$44

—

00074003956

ORILISSA 200 MG TABLET

Prescription Drug - Brand

$22

—

00074012402

HUMIRA(CF) PEN 80 MG/0.8 ML

Prescription Drug - Brand

$6,730

—

00074012403

HUMIRA(CF) PEN CROHN'S-UC-HS STARTER 80 MG/0.8 ML

Prescription Drug - Brand

$6,745

—

00074024302

HUMIRA(CF) 40 MG/0.4 ML SYRINGE

Prescription Drug - Brand

$3,368

—

00074054130

GENGRAF 50 MG CAPSULE

Prescription Drug - Generic

$1

—

00074055402

HUMIRA(CF) PEN 40 MG/0.4 ML

Prescription Drug - Brand

$3,366

—

00074061602

HUMIRA(CF) 20 MG/0.2 ML SYRINGE

Prescription Drug - Brand

$3,366

—

00074101756

ORIAHNN 300-1-0.5 MG/300 MG CAPS

Prescription Drug - Brand

$22

—

00074104328

RINVOQ ER 45 MG TABLET

Prescription Drug - Brand

$460

—

00074105001

SKYRIZI 150 MG/ML SYRINGE

Prescription Drug - Brand

$22,942

—

00074107001

SKYRIZI 360 MG/2.4 ML ON-BODY

Prescription Drug - Brand

$9,679

—

00074153903

HUMIRA(CF) PEN PS-UV-ADOL HS START 80 MG/0.8 ML-40 MG/0.4 ML

Prescription Drug - Brand

$4,441

—

00074210001

SKYRIZI 150 MG/ML PEN

Prescription Drug - Brand

$22,808

—

00074227714

VICOPROFEN 7.5-200 MG TABLET

Prescription Drug - Brand

$4

—

00074227754

VICOPROFEN 200-7.5 MG TAB

Prescription Drug - Brand

$3

—

00074228013

MAVIK 4 MG TABLET

Prescription Drug - Brand

$2

—

00074230630

RINVOQ ER 15 MG TABLET

Prescription Drug - Brand

$229

—

00074231030

RINVOQ ER 30 MG TABLET

Prescription Drug - Brand

$229

—

00074234030

NORVIR 100 MG TABLET

Prescription Drug - Brand

$8

—

00074262584

MAVYRET 100-40 MG TABLET

Prescription Drug - Brand

$153

—

00074300590

ADVICOR 500 MG-20 MG TABLET

Prescription Drug - Brand

$6

—

00074300790

ADVICOR 1,000 MG-20 MG TABLET

Prescription Drug - Brand

$7

—

00074301090

ADVICOR 1,000 MG-40 MG TABLET

Prescription Drug - Brand

$8

—

00074301511

TEVETEN HCT 600-12.5 MG TAB

Prescription Drug - Brand

$5

—

00074304113

VICODIN 5-300 MG TABLET

Prescription Drug - Brand

$1

—

00074304353

VICODIN ES 7.5-300 MG TABLET

Prescription Drug - Brand

$1

—

00074305453

VICODIN HP 10-300 MG TABLET

Prescription Drug - Brand

$2

—

00074305846

K-TAB ER 8 MEQ TABLET

Prescription Drug - Brand

$0

—

00074307490

NIASPAN ER 500 MG TABLET

Prescription Drug - Brand

$5

—

00074307990

NIASPAN ER 750 MG TABLET

Prescription Drug - Brand

$7

—

00074308090

NIASPAN ER 1,000 MG TABLET

Prescription Drug - Brand

$9

—

00074310832

GENGRAF 25 MG CAPSULE

Prescription Drug - Brand

$2

—

00074310932

GENGRAF 100 MG CAPSULE

Prescription Drug - Brand

$7

—

00074316290

TRILIPIX DR 135 MG CAPSULE

Prescription Drug - Brand

$9

—

00074317390

TRICOR 48 MG TABLET

Prescription Drug - Brand

$1

—

00074318990

TRICOR 145 MG TABLET

Prescription Drug - Brand

$1

—

00074328713

TARKA ER 2-180 MG TABLET

Prescription Drug - Brand

$5

—

00074328913

TARKA ER 2-240 MG TABLET

Prescription Drug - Brand

$5

—

00074329013

TARKA ER 4-240 MG TABLET

Prescription Drug - Brand

$5

—

00074331290

SIMCOR 500-20 MG TABLET

Prescription Drug - Brand

$4

—

00074331590

SIMCOR 750-20 MG TABLET

Prescription Drug - Brand

$6

—

00074334603

LUPRON DEPOT 22.5 MG 3MO KIT

Prescription Drug - Brand

$6,516

—

00074345590

SIMCOR 1,000-20 MG TABLET

Prescription Drug - Brand

$8

—

00074345790

SIMCOR 1,000-40 MG TABLET

Prescription Drug - Brand

$8

—

00074345990

SIMCOR 500-40 MG TABLET

Prescription Drug - Brand

$4

—

My Cost List