Medical Procedure Costs

00085092402

LOTRISONE CREAM

Prescription Drug - Brand

$2

—

00085128801

NASONEX 50 MCG NASAL SPRAY

Prescription Drug - Brand

$14

—

00085132201

CLARINEX-D 12 HOUR TABLET

Prescription Drug - Brand

$5

—

00085132801

NOXAFIL 40 MG/ML SUSPENSION

Prescription Drug - Brand

$13

—

00085133401

CLARINEX 0.5 MG/ML (2.5 MG/5)

Prescription Drug - Brand

$1

—

00085137401

IMDUR ER 30 MG TABLET

Prescription Drug - Generic

$0

—

00085140101

FORADIL AEROLIZER 12 MCG CAP

Prescription Drug - Brand

$4

—

00085141702

TEMODAR 250 MG CAPSULE

Prescription Drug - Brand

$1,092

—

00085143004

TEMODAR 180 MG CAPSULE

Prescription Drug - Brand

$635

—

00085151903

TEMODAR 20 MG CAPSULE

Prescription Drug - Brand

$90

—

00085173301

AVELOX 400 MG TABLET

Prescription Drug - Brand

$29

—

00085173303

AVELOX ABC PACK 400 MG TAB

Prescription Drug - Brand

$28

—

00085202801

IMDUR ER 60 MG TABLET

Prescription Drug - Generic

$0

—

00085300403

TEMODAR 5 MG CAPSULE

Prescription Drug - Brand

$17

—

00085314901

ELOCON 0.1% CREAM

Prescription Drug - Brand

$3

—

00085331035

NITRO-DUR 0.2 MG/HR PATCH

Prescription Drug - Brand

$4

—

00085432402

NOXAFIL DR 100 MG TABLET

Prescription Drug - Brand

$66

—

00085461001

DULERA 200 MCG/5 MCG INHALER

Prescription Drug - Brand

$23

—

00085720601

DULERA 100 MCG/5 MCG INHALER

Prescription Drug - Brand

$23

—

00087606010

GLUCOPHAGE 500 MG TABLET

Prescription Drug - Brand

$1

—

00087606313

GLUCOPHAGE XR 500 MG TAB

Prescription Drug - Brand

$1

—

00087607111

GLUCOPHAGE 1,000 MG TABLET

Prescription Drug - Brand

$2

—

00087607411

GLUCOVANCE 5-500 MG TABLET

Prescription Drug - Brand

$1

—

00088210224

PRIFTIN 150 MG TABLET

Prescription Drug - Brand

$5

—

00088216130

ARAVA 20 MG TABLET

Prescription Drug - Brand

$38

—

00088221905

LANTUS SOLOSTAR 100 UNITS/ML

Prescription Drug - Brand

$24

—

00088222033

LANTUS 100 UNITS/ML VIAL

Prescription Drug - Brand

$24

—

00088250033

APIDRA 100 UNITS/ML VIAL

Prescription Drug - Brand

$27

—

00088250205

APIDRA SOLOSTAR 100 UNIT/ML

Prescription Drug - Brand

$11

—

0008U

Test for detecting Helicobacter pylori genes associated with antibiotic

Pathology/Laboratory

$598

—

00093009001

EPITOL 200 MG TABLET

Prescription Drug - Generic

$0

—

00093030801

CLEMASTINE FUM 2.68 MG TAB

Prescription Drug - Generic

$1

—

00093081955

NIFEDICAL XL 30 MG TABLET

Prescription Drug - Generic

$0

—

00093102255

NIFEDIAC CC 60 MG TABLET

Prescription Drug - Generic

$1

—

00093102301

NIFEDIAC CC 90 MG TABLET

Prescription Drug - Generic

$2

—

00093102406

NEFAZODONE HCL 100 MG TABLET

Prescription Drug - Generic

$1

—

00093102506

NEFAZODONE HCL 200 MG TABLET

Prescription Drug - Generic

$1

—

00093102606

NEFAZODONE HCL 250 MG TABLET

Prescription Drug - Generic

$1

—

00093209058

ZEOSA CHEWABLE TABLET

Prescription Drug - Generic

$2

—

00093214062

TRI-LO-SPRINTEC TABLET

Prescription Drug - Generic

$0

—

00093226801

AMOXICILLIN 250 MG TAB CHEW

Prescription Drug - Generic

$0

—

00093227234

AMOX-CLAV 400-57 MG TAB CHEW

Prescription Drug - Generic

$1

—

00093312298

JINTELI 1 MG-5 MCG TABLET

Prescription Drug - Generic

$1

—

00093313491

CAMRESE 0.15-0.03-0.01 MG TAB

Prescription Drug - Generic

$0

—

00093319501

KETOPROFEN 75 MG CAPSULE

Prescription Drug - Generic

$1

—

00093330428

RECLIPSEN 28 DAY TABLET

Prescription Drug - Generic

$0

—

00093330528

ZENCHENT 0.4 MG-35 MCG TABLET

Prescription Drug - Generic

$0

—

00093356026

PEG3350-SOD SUL-NACL-KCL-ASCB-C 100-7.5-2.691-1.015-5.9-4.7G

Prescription Drug - Generic

$75

—

00093360782

FLUTICASONE-SALMETEROL 55-14

Prescription Drug - Generic

$109

—

00093360882

FLUTICASONE-SALMETEROL 113-14

Prescription Drug - Generic

$110

—

My Cost List