Medical Procedure Costs

00074364103

LUPRON DEPOT 3.75 MG KIT

Prescription Drug - Brand

$1,828

—

00074364203

LUPRON DEPOT 7.5 MG KIT

Prescription Drug - Brand

$2,174

—

00074366303

LUPRON DEPOT 11.25 MG 3MO KIT

Prescription Drug - Brand

$5,464

—

00074372790

SYNTHROID 137 MCG TABLET

Prescription Drug - Brand

$2

—

00074379902

HUMIRA 40 MG/0.8 ML SYRINGE

Prescription Drug - Brand

$3,374

—

00074395646

KALETRA 80 MG-20 MG/ML SOLN

Prescription Drug - Brand

$3

—

00074431430

ZEMPLAR 2 MCG CAPSULE

Prescription Drug - Brand

$25

—

00074431730

ZEMPLAR 1 MCG CAPSULE

Prescription Drug - Brand

$13

—

00074433902

HUMIRA PEN 40 MG/0.8 ML

Prescription Drug - Brand

$3,366

—

00074433906

HUMIRA PEN CROHN'S-UC-HS STARTER 40 MG/0.8 ML

Prescription Drug - Brand

$3,364

—

00074433907

HUMIRA PEN PSORIASIS-UVEITIS-ADOL HS STARTER 40 MG/0.8 ML

Prescription Drug - Brand

$3,365

—

00074434190

SYNTHROID 25 MCG TABLET

Prescription Drug - Brand

$2

—

00074455290

SYNTHROID 50 MCG TABLET

Prescription Drug - Brand

$2

—

00074518290

SYNTHROID 75 MCG TABLET

Prescription Drug - Brand

$2

—

00074568216

DEPAKENE 250 MG/5 ML SOLUTION

Prescription Drug - Brand

$1

—

00074611411

DEPAKOTE 125 MG SPRINKLE CAP

Prescription Drug - Brand

$2

—

00074611413

DEPAKOTE DR 125 MG SPRINKLE CP

Prescription Drug - Brand

$2

—

00074659490

SYNTHROID 88 MCG TABLET

Prescription Drug - Brand

$2

—

00074662490

SYNTHROID 100 MCG TABLET

Prescription Drug - Brand

$2

—

00074663330

NORVIR 100 MG SOFTGEL CAP

Prescription Drug - Brand

$8

—

00074679922

KALETRA 200-50 MG TABLET

Prescription Drug - Brand

$8

—

00074706890

SYNTHROID 125 MCG TABLET

Prescription Drug - Brand

$2

—

00074706990

SYNTHROID 150 MCG TABLET

Prescription Drug - Brand

$2

—

00074707090

SYNTHROID 175 MCG TABLET

Prescription Drug - Brand

$2

—

00074709430

QULIPTA 60 MG TABLET

Prescription Drug - Brand

$38

—

00074709530

QULIPTA 10 MG TABLET

Prescription Drug - Brand

$38

—

00074709630

QULIPTA 30 MG TABLET

Prescription Drug - Brand

$38

—

00074709806

VUITY 1.25% EYE DROP

Prescription Drug - Brand

$24

—

00074714890

SYNTHROID 200 MCG TABLET

Prescription Drug - Brand

$2

—

00074714990

SYNTHROID 300 MCG TABLET

Prescription Drug - Brand

$2

—

00074726950

GENGRAF 100 MG/ML SOLUTION

Prescription Drug - Generic

$3

—

00074732513

DEPAKOTE DR 125 MG TABLET

Prescription Drug - Brand

$2

—

00074732613

DEPAKOTE DR 250 MG TABLET

Prescription Drug - Brand

$4

—

00074732713

DEPAKOTE DR 500 MG TABLET

Prescription Drug - Brand

$7

—

00074740113

DEPAKOTE ER 250 MG TABLET

Prescription Drug - Brand

$4

—

00074740213

DEPAKOTE ER 500 MG TABLET

Prescription Drug - Brand

$6

—

00074780419

K-TAB ER 10 MEQ TABLET

Prescription Drug - Brand

$1

—

00074929690

SYNTHROID 112 MCG TABLET

Prescription Drug - Brand

$2

—

00074964290

TRILIPIX DR 45 MG CAPSULE

Prescription Drug - Brand

$3

—

00075062281

LOVENOX 80 MG/0.8 ML SYRINGE

Prescription Drug - Brand

$80

—

00075062301

LOVENOX 100 MG/ML SYRINGE

Prescription Drug - Brand

$80

—

00075245201

DDAVP 0.01% NASAL SPRAY

Prescription Drug - Brand

$76

—

00075801410

LOVENOX 40 MG/0.4 ML SYRINGE

Prescription Drug - Brand

$7

—

00078017615

LESCOL 20 MG CAPSULE

Prescription Drug - Brand

$5

—

00078023415

LESCOL 40 MG CAPSULE

Prescription Drug - Brand

$5

—

00078024061

SANDIMMUNE 25 MG CAPSULE

Prescription Drug - Brand

$4

—

00078024161

SANDIMMUNE 100 MG CAPSULE

Prescription Drug - Brand

$15

—

00078024661

NEORAL 25 MG GELATIN CAPSULE

Prescription Drug - Brand

$3

—

00078024861

NEORAL 100 MG GELATIN CAPSULE

Prescription Drug - Brand

$12

—

00078024915

FEMARA 2.5 MG TABLET

Prescription Drug - Brand

$27

—

My Cost List