Medical Procedure Costs

00078051824

GENTEAL MILD-MODERATE EYE DROP

Prescription Drug - Brand

$0

—

00078051982

HYPOTEARS EYE DROPS

Prescription Drug - Generic

$0

—

00078052651

TASIGNA 200 MG CAPSULE

Prescription Drug - Brand

$94

—

00078052705

STALEVO 200 TABLET

Prescription Drug - Brand

$7

—

00078055915

EXFORGE HCT 5-160-12.5 MG TAB

Prescription Drug - Brand

$9

—

00078056015

EXFORGE HCT 5-160-25 MG TAB

Prescription Drug - Brand

$8

—

00078056130

EXFORGE HCT 10-160-12.5 MG TAB

Prescription Drug - Brand

$8

—

00078056215

EXFORGE HCT 10-160-25 MG TAB

Prescription Drug - Brand

$10

—

00078056315

EXFORGE HCT 10-320-25 MG TAB

Prescription Drug - Brand

$15

—

00078056751

AFINITOR 10 MG TABLET

Prescription Drug - Brand

$462

—

00078056845

COARTEM TABLETS

Prescription Drug - Brand

$5

—

00078060315

TEKAMLO 150 MG-5 MG TABLET

Prescription Drug - Brand

$4

—

00078060515

TEKAMLO 300 MG-5 MG TABLET

Prescription Drug - Brand

$5

—

00078060615

TEKAMLO 300 MG-10 MG TABLET

Prescription Drug - Brand

$5

—

00078060715

GILENYA 0.5 MG CAPSULE

Prescription Drug - Brand

$415

—

00078060905

FOCALIN XR 35 MG CAPSULE

Prescription Drug - Brand

$5

—

00078061415

AMTURNIDE 300-10-25 MG TAB

Prescription Drug - Brand

$5

—

00078061605

HECORIA 0.5 MG CAPSULE

Prescription Drug - Generic

$0

—

00078061705

HECORIA 1 MG CAPSULE

Prescription Drug - Generic

$1

—

00078061805

HECORIA 5 MG CAPSULE

Prescription Drug - Generic

$7

—

00078061915

ARCAPTA NEOHALER 75 MCG CAP

Prescription Drug - Brand

$8

—

00078063941

COSENTYX SENSOREADY 300 MG DOSE/2 PENS (150 MG/PEN)

Prescription Drug - Brand

$3,951

—

00078063968

COSENTYX SENSOREADY 150 MG/ML PEN

Prescription Drug - Brand

$7,874

—

00078063997

COSENTYX 150 MG/ML SYRINGE

Prescription Drug - Brand

$7,923

—

00078063998

COSENTYX (150 MG/ML) 300 MG DOSE-2 SYRINGES

Prescription Drug - Brand

$3,966

—

00078064930

GLEEVEC 400 MG TABLET

Prescription Drug - Brand

$328

—

00078065967

ENTRESTO 24 MG-26 MG TABLET

Prescription Drug - Brand

$12

—

00078066419

UTIBRON NEOHALER 27.5-15.6 MCG

Prescription Drug - Brand

$6

—

00078069667

ENTRESTO 97 MG-103 MG TABLET

Prescription Drug - Brand

$12

—

00078072915

BETOPTIC S 0.25% EYE DROP

Prescription Drug - Brand

$43

—

00078073610

ALOMIDE 0.1% EYE DROP

Prescription Drug - Brand

$20

—

00078077767

ENTRESTO 49 MG-51 MG TABLET

Prescription Drug - Brand

$12

—

00078079061

SANDOSTATIN LAR DEPOT 10 MG VL

Prescription Drug - Brand

$3,371

—

00078079761

SANDOSTATIN LAR DEPOT 20 MG VL

Prescription Drug - Brand

$4,409

—

00078079975

CIPRODEX OTIC SUSPENSION

Prescription Drug - Brand

$32

—

00078080461

SANDOSTATIN LAR DEPOT 30 MG VL

Prescription Drug - Brand

$6,681

—

00078081181

SANDOSTATIN LAR DEPOT 10 MG KT

Prescription Drug - Brand

$3,371

—

00078081301

TOBREX 0.3% EYE OINTMENT

Prescription Drug - Brand

$84

—

00078081881

SANDOSTATIN LAR DEPOT 20 MG KT

Prescription Drug - Brand

$4,409

—

00078082581

SANDOSTATIN LAR DEPOT 30 MG KT

Prescription Drug - Brand

$6,681

—

00078087601

TOBRADEX EYE OINTMENT

Prescription Drug - Brand

$90

—

00078090221

KISQALI 600 MG DAILY DOSE

Prescription Drug - Brand

$290

—

00078090438

SIMBRINZA 1%-0.2% EYE DROPS

Prescription Drug - Brand

$24

—

00078095325

TOBRADEX EYE DROPS

Prescription Drug - Brand

$35

—

00078100768

KESIMPTA 20 MG/0.4 ML PEN

Prescription Drug - Brand

$24,459

—

00078107068

COSENTYX UNOREADY 300 MG/2 ML PEN (1 PEN)

Prescription Drug - Brand

$4,106

—

00078123820

ENTRESTO SPRINKLE 15-16 MG PLT

Prescription Drug - Brand

$12

—

0007M

Molecular pathology test for genetic analysis of tumors in the digestive system

Pathology/Laboratory

$375

—

0007U

Testing for presence of drug in urine

Pathology/Laboratory

$114

—

00085081935

NITRO-DUR 0.8 MG/HR PATCH

Prescription Drug - Brand

$6

—

My Cost List